Discover and read the best of Twitter Threads about #vascularaccesspearls
Most recents (18)
💥 Role of Stents in Dialysis Vascular Access - Tweetorial
⚡️Indications for Stent Use
⚡️Recent Clinical Trials of Stents in Dialysis Vascular Access
⚡️Complications associated with Stent Use
1/
@ASDINNews
#VascularAccessPearls
⚡️Indications for Stent Use
⚡️Recent Clinical Trials of Stents in Dialysis Vascular Access
⚡️Complications associated with Stent Use
1/
@ASDINNews
#VascularAccessPearls
⚡️Arterio-venous (AV) Access
causes significant morbidity & mortality in patients on hemodialysis
⚡️Most AV access associated complications are due to vascular stenosis👇🏽
2/
causes significant morbidity & mortality in patients on hemodialysis
⚡️Most AV access associated complications are due to vascular stenosis👇🏽
2/
⚡️Vascular Access care has evolved over the past 60 years:
-Scribner’s Shunt in 1960 ➡️
-Brescia-Cimino AVF in 1966 ➡️
-1st Balloon Angioplasty in 1981 ➡️
-1st Bare Metal Stent in 1988 ➡️
-1st Covered Stent in 1996 ➡️
-DCB use in 2012
3/
-Scribner’s Shunt in 1960 ➡️
-Brescia-Cimino AVF in 1966 ➡️
-1st Balloon Angioplasty in 1981 ➡️
-1st Bare Metal Stent in 1988 ➡️
-1st Covered Stent in 1996 ➡️
-DCB use in 2012
3/
Check out the latest issue of @ackdonline edited by @DrAnil001 and @bharvioza
"Dialysis Access: What is on the Horizon?"
#VascularAccessPearls #Nephpearls
sciencedirect.com/journal/advanc…
"Dialysis Access: What is on the Horizon?"
#VascularAccessPearls #Nephpearls
sciencedirect.com/journal/advanc…
KDOQI 2019 Vascular Access Guidelines: What Is New? from @ackdonline @charmaine_lok @LouiseMoist1
#VascularAccessPearls #Nephpearls
ackdjournal.org/article/S1548-…
#VascularAccessPearls #Nephpearls
ackdjournal.org/article/S1548-…
Vessel Preservation in CKD from @ackdonline @tvachh @AimenLiaqat
#VascularAccessPearls #Nephpearls
ackdjournal.org/article/S1548-…
#VascularAccessPearls #Nephpearls
ackdjournal.org/article/S1548-…
💥Buttonhole cannulation, has been shown to be associated with ⬆️ rate of infections: local infections + bacteremia👇🏽
💥But can proper patient selection & the right BH technique allow us to use it in some patients?
#VascularAccessPearls
@ASDINNews
💥But can proper patient selection & the right BH technique allow us to use it in some patients?
#VascularAccessPearls
@ASDINNews
This RCT showed that BH cannulation was associated with twice as many infections compared to the standard needling technique👇🏽
💥Why does Buttonhole cannulation cause infection? 👇🏽
Patient selection, education and cannulation of percutaneous arteriovenous fistulae (pAVF) being presented by @wasse_m
#VascularAccessPearls #Nephpearls #ASDIN2020
👉🏼 cdn.ymaws.com/www.asdin.org/…
#VascularAccessPearls #Nephpearls #ASDIN2020
👉🏼 cdn.ymaws.com/www.asdin.org/…
Role of percutaneous AVF (pAVF) in ESKD Patient Life-Plan
#ASDIN2020 #Nephpearls
👉🏼 Illustration courtesy of @robshahverdyan
#ASDIN2020 #Nephpearls
👉🏼 Illustration courtesy of @robshahverdyan
💥’Endovascular AVF for Dialysis’ -
Tweetorial
⚡️What is an Endovascular Arteriovenous Fistula?
⚡️How is an EndoAVF different from a surgically created AVF?
⚡️EndoAVF Outcomes?
@ASDINNews
#EndoAVF
#VascularAccessPearls
1/
Tweetorial
⚡️What is an Endovascular Arteriovenous Fistula?
⚡️How is an EndoAVF different from a surgically created AVF?
⚡️EndoAVF Outcomes?
@ASDINNews
#EndoAVF
#VascularAccessPearls
1/
💥First a poll:
In the next few years, Endovascular AVF will completely replace the Surgical AVF for hemodialysis
In the next few years, Endovascular AVF will completely replace the Surgical AVF for hemodialysis
💥Let’s first briefly review the Surgical-AVFs
⚡️In 1966, Brescia & Cimino described the creation of the Radial-Cephalic AVF in the distal arm👇🏽
⚡️This proved to be revolutionary & AVF became the dialysis vascular access of choice
2/
⚡️In 1966, Brescia & Cimino described the creation of the Radial-Cephalic AVF in the distal arm👇🏽
⚡️This proved to be revolutionary & AVF became the dialysis vascular access of choice
2/
💥Swelling & Pain at the dialysis AV access site - don’t forget this entity in your differential diagnosis
⚡️Though it is rare it usually carries a very poor prognosis👇🏽
@ASDINNews
#VascularAccessPearls
⚡️Though it is rare it usually carries a very poor prognosis👇🏽
@ASDINNews
#VascularAccessPearls
⚡️This is Angiosarcoma at an old AVG site
⚡️Patient was no longer on dialysis as she had a functioning renal allograft & was on Immunosuppression 👇🏽
⚡️Published in #JournalOfVascularAccess
⚡️Patient was no longer on dialysis as she had a functioning renal allograft & was on Immunosuppression 👇🏽
⚡️Published in #JournalOfVascularAccess
⚡️A few more case reports 👇🏽
💥’Dialysis AV Fistula & the Heart:
Friend or Foe?’ - Tweetorial
⚡️Let’s review the following:
☄️Hemodynamic effects of an AVF
☄️Impact of AVF on Cardiac Structure
& Function
1/
@ASDINNews
@RenalFellowNtwk
#VascularAccessPearls
Friend or Foe?’ - Tweetorial
⚡️Let’s review the following:
☄️Hemodynamic effects of an AVF
☄️Impact of AVF on Cardiac Structure
& Function
1/
@ASDINNews
@RenalFellowNtwk
#VascularAccessPearls
💥Why is it important to understand the impact of AVF on the heart?
⚡️Because AVF use has ⬆️ in 🇺🇸
⚡️Cardiac disease is highly prevalent among ESRD pts.
⚡️50% of all ESRD deaths are due to
a CV-related cause👇🏽
2/
⚡️Because AVF use has ⬆️ in 🇺🇸
⚡️Cardiac disease is highly prevalent among ESRD pts.
⚡️50% of all ESRD deaths are due to
a CV-related cause👇🏽
2/
💥What causes cardiac disease in ESRD patients?
⚡️Many factors contribute to it - as shown below👇🏽
⚡️In this tweetorial, the focus will be on how the AVF affects the heart
3/
⚡️Many factors contribute to it - as shown below👇🏽
⚡️In this tweetorial, the focus will be on how the AVF affects the heart
3/
💥 Dialysis Access Associated Venous Thoracic Outlet Syndrome (VTOS) is a rare but under-recognized cause of central vein stenosis in dialysis patients
⚡️Tweetorial on Dialysis Access Associated VTOS 👇🏽
1/
@ASDINNews
@MedTweetorials
#VascularAccessPearls
⚡️Tweetorial on Dialysis Access Associated VTOS 👇🏽
1/
@ASDINNews
@MedTweetorials
#VascularAccessPearls
💥Venous Thoracic Outlet Syndrome
is due to:
⚡️Subclavian Vein stenosis caused by
it’s compression in the thoracic
outlet
⚡️Thoracic outlet is formed by the 1st
Rib, Clavicle & Subclavius
muscle👇🏽
2/
is due to:
⚡️Subclavian Vein stenosis caused by
it’s compression in the thoracic
outlet
⚡️Thoracic outlet is formed by the 1st
Rib, Clavicle & Subclavius
muscle👇🏽
2/
💥 Subclavian vein stenosis due to thoracic outlet compression can occur in healthy individuals & can present with:
⚡️Intermittent positional venous obstruction (McCleery Syndrome)
⚡️Venous thrombosis (Paget-Schroetter Syndrome)
3/
⚡️Intermittent positional venous obstruction (McCleery Syndrome)
⚡️Venous thrombosis (Paget-Schroetter Syndrome)
3/
💥Teaching point re: Rx of dialysis catheter related bacteremia
⚡️IV antibiotic alone is NEVER the correct Rx choice
Rx options are:
☄️IV antibiotic + CVC antibiotic
lock solution
OR
☄️IV antibiotic + CVC exchange
@ASDINNews
#VascularAccessPearls
1/
⚡️IV antibiotic alone is NEVER the correct Rx choice
Rx options are:
☄️IV antibiotic + CVC antibiotic
lock solution
OR
☄️IV antibiotic + CVC exchange
@ASDINNews
#VascularAccessPearls
1/
💥The reason IV antibiotic alone is not the correct choice is because it does not eradicate the bacteria in the CVC lumen biofilm
⚡️For effective clearance of bacteria from the biofilm you have to use CVC antibiotic lock solution or exchange the CVC
2/
⚡️For effective clearance of bacteria from the biofilm you have to use CVC antibiotic lock solution or exchange the CVC
2/
💥The choice of antibiotic for catheter related bacteremia is listed below👇🏽
⚡️How to prepare the CVC antibiotic lock solution?👇🏽
@RenalFellowNtwk
3/
⚡️How to prepare the CVC antibiotic lock solution?👇🏽
@RenalFellowNtwk
3/
💥What would you do if the dialysis catheter clamp breaks?
@RenalFellowNtwk
@ASDINNews
#VascularAccessPearls
1/
@RenalFellowNtwk
@ASDINNews
#VascularAccessPearls
1/
💥Image of a dialysis catheter with a broken clamp 👇🏽
2/
2/
💥As long as there is >4 cm catheter extension tubing available, you can proceed with a clamp exchange for a broken clamp
⚡️Here is how you can do it using a
catheter repair kit 👇🏽
3/
(some images downloaded from
the internet)
⚡️Here is how you can do it using a
catheter repair kit 👇🏽
3/
(some images downloaded from
the internet)
💥’Physical Examination of the Dialysis Vascular Access’ - Tweetorial
Let’s first review the:
⚡️Anatomy of the Vascular Access
⚡️Vascular Access-related
complications
1/
@ASDINNews
@RenalFellowNtwk
#VascularAccessPearls
Let’s first review the:
⚡️Anatomy of the Vascular Access
⚡️Vascular Access-related
complications
1/
@ASDINNews
@RenalFellowNtwk
#VascularAccessPearls
💥 A dialysis vascular access is a ‘circuit’ and NOT just a ‘connection’ between an artery & a vein
⚡️The circuit consists of:
☄️ Pump (heart)
☄️ Inflow (artery)
☄️ Conduit (body of the access)
☄️ Outflow (vein)
2/
⚡️The circuit consists of:
☄️ Pump (heart)
☄️ Inflow (artery)
☄️ Conduit (body of the access)
☄️ Outflow (vein)
2/
💥 There are 3 basic types of vascular access:
⚡️AVF (arterio-venous fistula)
⚡️AVG (arterio-venous graft)
⚡️CVC (central venous catheter)
☄️AVF: created by a direct connection b/w an artery & a vein
☄️AVG: graft is interposed b/w an artery & a vein👇🏽
3/
⚡️AVF (arterio-venous fistula)
⚡️AVG (arterio-venous graft)
⚡️CVC (central venous catheter)
☄️AVF: created by a direct connection b/w an artery & a vein
☄️AVG: graft is interposed b/w an artery & a vein👇🏽
3/
Cephalic arch stenosis: A practical review of an evolving disease ca. 2014 #VascularAccessPearls #Nephpearls
👉🏼 academia.edu/20818749/Cepha… via @academia
👉🏼 academia.edu/20818749/Cepha… via @academia
Cephalic arch stenosis may be a long-term consequence of high blood flow rates ca. 2007
#VascularAccessPearls #Nephpearls
👉🏼 journals.sagepub.com/doi/pdf/10.117…
#VascularAccessPearls #Nephpearls
👉🏼 journals.sagepub.com/doi/pdf/10.117…
Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis ca. 2018
#VascularAccessPearls #Nephpearls
👉🏼 journals.sagepub.com/doi/full/10.11…
#VascularAccessPearls #Nephpearls
👉🏼 journals.sagepub.com/doi/full/10.11…
📌Can you tell where the dialysis catheter is located? 👇🏽
📌What potential complications can occur?
@ASDINNews
@RenalFellowNtwk
@KidneyAcademy
#VascularAccessPearls
📌What potential complications can occur?
@ASDINNews
@RenalFellowNtwk
@KidneyAcademy
#VascularAccessPearls
-The CVC path: Right atrium -> interatrial septum -> Left atrium -> mediastinum
-Furthermore repositioning of CVC resulted in hemodynamic shock -> pericardial effusion
-Case Report 👇🏽
journals.sagepub.com/doi/pdf/10.530…
-Furthermore repositioning of CVC resulted in hemodynamic shock -> pericardial effusion
-Case Report 👇🏽
journals.sagepub.com/doi/pdf/10.530…
Do you know what an ‘Oreo Cookie’ Sign is?
It is seen in Pericardial Effusion 👇🏽
It is seen in Pericardial Effusion 👇🏽
💥Tweetorial on ‘Are AVF’s the best dialysis vascular access?
⚡️Do AVFs have better long term patency than AVGs?
⚡️Impact of vascular access type on clinical outcomes?
⚡️Are AVFs cost effective in all pts?
@RenalFellowNtwk
#VascularAccessPearls
⚡️Do AVFs have better long term patency than AVGs?
⚡️Impact of vascular access type on clinical outcomes?
⚡️Are AVFs cost effective in all pts?
@RenalFellowNtwk
#VascularAccessPearls
💥Do AVF’s have better long term patency than AVGs?
⚡️Observational studies have shown that AVFs have better cumulative access survival than AVGs but...👇🏽
⚡️Observational studies have shown that AVFs have better cumulative access survival than AVGs but...👇🏽
💥Why is it important to look at the cumulative AV access survival from the ‘Time of AV access creation’ and NOT from the ‘Time of successful AV access use’?
⚡️Let’s take a look at this study which compared the cumulative survival of AVF vs. AVG 👇🏽
⚡️Let’s take a look at this study which compared the cumulative survival of AVF vs. AVG 👇🏽
💥Dialysis AV access aneurysms/pseudo-aneurysms come in all shapes and sizes 👇🏽
⚡️Risk factors include repeated cannulation at the same site and high intra-access pressures
⚡️When is surgical intervention indicated? 👇🏽
#VascularAccessPearls
⚡️Risk factors include repeated cannulation at the same site and high intra-access pressures
⚡️When is surgical intervention indicated? 👇🏽
#VascularAccessPearls
💥More AV access images - Ulcer, Eschar, Hypopigmentation, Shiny skin 👇🏽
#VascularAccessPearls
@ASDINNews
#VascularAccessPearls
@ASDINNews
AVG Pseudo-aneurysms. Rotation of the cannulation site in important to avoid this 👇🏽
#VascularAccessPearls
#VascularAccessPearls
💥Which of these predict AVF Maturation?
⚡️Pre-op Venous and Arterial Intimal
Hyperplasia?
⚡️Post-op AVF stenosis?
⚡️Pre-existing functional vascular
characteristics?
⚡️Post-op AVF Ultrasound?
👇🏽👇🏽👇🏽
#VascularAccessPearls
@ASDINNews
⚡️Pre-op Venous and Arterial Intimal
Hyperplasia?
⚡️Post-op AVF stenosis?
⚡️Pre-existing functional vascular
characteristics?
⚡️Post-op AVF Ultrasound?
👇🏽👇🏽👇🏽
#VascularAccessPearls
@ASDINNews
💥Why was pre-op venous intimal hyperplasia NOT associated with AVF maturation failure?
⚡️Likely because these lesions are histologically quiescent: Lack inflammatory cells (CD68) and proliferative activity (Ki67)👇🏽👇🏽👇🏽
#VascularAccessPearls
@ASDINNews
⚡️Likely because these lesions are histologically quiescent: Lack inflammatory cells (CD68) and proliferative activity (Ki67)👇🏽👇🏽👇🏽
#VascularAccessPearls
@ASDINNews
💥Two recent studies reported on the outcomes of the Second AVF after the First AVF failed to mature 👇🏽
⚡️@JVascSurg - Secondary AVF vs. Secondary AVG
⚡️ @AJKDonline - Second AVF vs. First AVF
@hswapnil
#VisualAbstracts 👇🏽 #VascularAccessPearls
⚡️@JVascSurg - Secondary AVF vs. Secondary AVG
⚡️ @AJKDonline - Second AVF vs. First AVF
@hswapnil
#VisualAbstracts 👇🏽 #VascularAccessPearls
