Dialysis Access Management

This updated volume covers the basic principles and practice of dialysis access management. To cover the latest trends and evidence from clinical trials, new chapters on the management of cephalic arch stenosis and swing zone stenosis, the role of drug eluting balloon in dialysis access interventions, the management of central vein stenosis, endovascular creation of AVF, and the management of steal syndrome have been included. Dialysis Access Management gives readers a step-by-step guide to endovascular interventions with special emphasis on the principles and rationale behind these approaches. This book is an essential text for residents, fellows, and physicians who are learning or practicing in dialysis, especially in the fields of nephrology, radiology, surgery, and vascular medicine. Contents 1: Brief Introduction of Hemodialysis and Vascular Access Introduction The First Hemodialysis The First Arteriovenous Access Trends in Hemodialysis References 2: Angiographic Imaging Equipment Introduction Angiographic Imaging System C-arm Foot Switch Monitor Console Table and Control Panel Imaging Options Pulsed Fluoroscopy Fluoroscopy Versus Digital Subtraction Angiography (DSA) Collimation versus Magnification Optimizing Image Quality 3: Endovascular Tools Introduction Access Needle Sheath Dilator Catheter Non Selective or Flush Catheter Selective Catheter Guiding Catheters Guidewire Balloon Catheter Stents References 4: Basic Endovascular Skills and Techniques Introduction Preparation for Intervention The Initial Puncture Sheath Placement Contrast Material and Fluoroscopy Tips Sheath Removal 5: Radiation Safety Introduction Definitions and Units Radiation Exposure Air Kerma Absorbed Dose Peak Skin Dose Kerma-Area Product (KAP) Effective Dose Effects of Radiation Deterministic Effects Stochastic Effects Dose Limits Whole Body Dose Extremity Dose Methods to Reduce Radiation Exposure During Dialysis Access Interventions Pre-procedure Planning Procedural Techniques for Patient Radiation Dose Reduction Collimation Exposure Time Object-Detector and Source-Detector Distances Last Image Hold Reduction of Pulse Rate Digitally Subtracted Angiography Road Mapping Documentation of Radiation Exposure Ultrasound Image Noise Reduction Patient Follow-Up Radiation Exposure to the Interventionist Conclusion References 6: Conscious Sedation and Anesthesia Care Pre-procedural Evaluation Safety in Sedation Monitoring, Airway Devices and Anesthesia Machine Sedation Levels and General Anesthesia [4] Moderate Sedation Deep Sedation General Anesthesia Monitored Anesthesia Care Local Anesthetics and Intravenous Sedation Regional Anesthesia Intravenous Agents Sedation and Analgesia Related Complications and Treatment Local Anesthetics Intravenous Agents Reversal Agents or Antagonists Postprocedure Recovery References 7: Vascular Anatomy for Hemodialysis Access Introduction Arterial Supply of the Upper Limb (Fig. 7.1a) Venous Drainage of the Upper Limb and Thorax Arterial Supply and Venous Drainage of the Lower Limbs Venous Anatomy of the Neck References 8: Hemodialysis Access: Types Introduction Arteriovenous Fistula Arteriovenous Graft Dialysis Catheter Conclusion References 9: Physical Examination of Dialysis Vascular Access and Vascular Access Surveillance Introduction Physical Examination Inspection Palpation Maneuvers Pulse Augmentation Arm Elevation Auscultation Surveillance Hemodialysis Dose and Adequacy Access Dysfunction and Recirculation References 10: Non-invasive Imaging of Dialysis Access Circuit Introduction Indications Ultrasound Acquisition, Display and Transducers Doppler Imaging Procedure Diagnostic Criteria Pitfalls Computed Tomography Angiography MRI/MRA Conclusions References 11: Angiogram and Angioplasty Introduction Venous Intervention Equipment Fistulogram and Angioplasty Graftogram and Angioplasty Tips and Troubleshooting References 12: Declotting of Dialysis Vascular Access Introduction Methods of Declotting Equipment (Fig. 12.2) Declotting of AVG Declotting of AVF Tips and Troubleshooting References 13: Endovascular Stent Placement Introduction Equipment Steps for Stent Deployment Troubleshooting References 14: Minimally Invasive Banding Procedure Introduction Equipment for MILLER Procedure Steps for MILLER Procedure Tips and Troubleshooting Modifications of the MILLER Procedure References 15: Peripheral Arterial Disease in Hemodialysis Access Introduction Normal and Variant Anatomy Pathophysiology Risk Factors Signs and Symptoms Diagnosis Management References 16: Swing Point Stenosis Introduction Juxta-Anastomotic Stenosis (JAS) General Etiology Prevention Diagnosis by Physical Examination Management Basilic Angle of Transposition Stenosis (BATS) General Diagnosis by Physical Examination Management Cephalic Arch Stenosis (CAS) General Unique Nature of the Cephalic Arch Etiology of CAS Incidence of CAS CAS in Diabetics Variability in Location of Stenosis Diagnosis by Physical Examination Prevention of CAS Management of Cephalic Arch Stenosis Treatment Modalities Primary Treatment Percutaneous Balloon Angioplasty (PTA) Blood Flow Reduction Secondary Treatment Intravascular Stent Placement Surgical Management of CAS Proposed Algorithm for the Management of CAS References 17: Thoracic Central Vein Obstruction Introduction Definition of Thoracic Central Venous System Incidence of TCVO Etiology of TCVO Venous Wall Thickening Central Venous Catheters Peripherally Inserted Central Catheter Cardiac Implantable Electronic Device Bare-metal Stents and Stent Grafts De novo Stenosis Endoluminal Obstruction Central Vein Thrombosis Stents External Compression of Central Veins Ectatic Aortic Arch Costoclavicular Junction Compression Collateral Circulation Associated with TCVO Collateral Pathways Jugular Collateral Pathway Lateral Thoracic Collateral Pathway Anterior Thoracic Collateral Pathway Azygous Pathway Collaterals Associated with Site of Occlusion Internal Jugular Vein (IJ V) Subclavian Vein (SV) Brachiocephalic Vein (BCV) Superior Vena Cava Occlusion Above Azygos Vein Superior Vena Cava Occlusion Below Azygos Vein Collateral Decompression of TCVO Clinical Consequences of TCVO Mechanism of Arm Edema Level of TCVO Involvement TCVO Level 1 TCVO Level 2 TCVO Level 3 Superior Vena Caval Syndrome TCVO Level 4 Management of TCVO Asymptomatic TCVO Symptomatic TCVO Endovascular Management Percutaneous Transluminal Angioplasty (PTA) Stent Placement Bare-Metal Stents (BMS) Stent-graft (SG) PTA Versus Stenting Advanced Endovascular Techniques Sharp Recanalization Radiofrequency Recanalization Surgical Management Banding Surgical Bypass Costoclavicular Junction Decompression Closure of Access Creation of AV Access in Patients with TCVO References 18: Vascular Steal Introduction Hemodialysis Access-Induced Distal Ischemia (HAIDI) Risk Factors Pathogenesis Role of the AV Access and Draining Veins Role of the Feeding Artery Role of Collateral Arteries Role of Artery Distal to Anastomosis Role of Peripheral Vascular Bed of Hand Signs and Symptoms Classification of HAIDI Clinical Classification Grade 1 Grade 2 Grade 2a Grade 2b Grade 3 Grade 4 Grade 4a Grade 4b Classification Based Upon Time of Onset Diagnosis Ultrasound Evaluation Angiographic Evaluation Digital Blood Pressure Evaluation Nerve Conduction Evaluation Differential Diagnosis Prevention Demographic Characteristics Clinical Evaluation Vascular Mapping Digital Blood Pressure Assessment Surgical Planning Intraoperative Evaluation Treatment Clinical Status and Prognosis Clinical Grade of HAIDI Grade 1 Grade 2 Grade 3 Grade 4 Status of the Arteries Proximal and Distal to Anastomosis Location of Arterial Anastomosis Forearm Upper Arm Low to Normal Access Blood Flow Proximalization of the Arterial Inflow (PAI) Distal Revascularization with Interval Ligation (DRIL) High Access Blood Flow Precision Banding Revision Using Distal Inflow (RUDI) Last Resort Ischemic Monomelic Neuropathy Incidence Clinical Features Pathogenesis Diagnosis Differential Diagnosis Management Subclavian Steal Syndrome Subclavian-Coronary Artery Steal Syndrome Subclavian-Vertebral Artery Steal Syndrome Pathogenesis Management References 19: Role of Drug-Eluting Balloons in Dialysis Access Interventions Introduction Equipment Lutonix DCB Indication for Use Contraindications Device Handling and Application Prior Studies IN.PACT AV DCB Indications for Use Contraindications Device Handling and Application Prior Studies Stellarex DCB Indication for Use Contraindications Device Handling and Application Pre-Procedure Post-Procedure Prior Studies References 20: Non-tunneled Hemodialysis Catheter Introduction Sites of Insertion Equipment Steps for Right IJ Non-Tunneled Catheter Insertion Complications of Non-Tunneled Catheter Insertion Acute Complications Subacute Complications Timing of Removal of Non-Tunneled Dialysis Catheter References 21: Tunneled Hemodialysis Catheter Insertion of Tunneled Dialysis Catheter Introduction Sites of Insertion General Features of Tunneled Dialysis Catheter Equipment Steps for a Right Sided IJ Tunneled Catheter Insertion Optimal Dialysis Catheter Tip Placement Challenging Dialysis Catheter Insertion (Table 21.1) Acute Complications of Tunneled Dialysis Catheter Insertion Arterial Puncture Pneumothorax Hemothorax Air Embolism Cardiac Arrhythmia Vessel Injury During Dilatation of the Venotomy Tract Subacute Complications of Tunneled Dialysis Catheter Suboptimal Flow Catheter-Related Infection Catheter-related Bloodstream Infections (CRBSI) Tunnel Tract Infection Exit Site Infection Removal of Tunneled Dialysis Catheter Introduction Steps for Catheter Removal Some of the potential problem and steps for troubleshotting are summarised in Table 21.2. References 22: Surgical Placement of Hemodialysis Vascular Accesses Introduction Creation of Autogenous Arteriovenous Fistulas Equipment for AVF Creation (Fig. 22.1) Steps of AVF Creation (Brachiocephalic AVF) Placement of Prosthetic Arteriovenous Grafts Equipment for AVG Placement (Fig. 22.7) Steps of AVG Placement (Brachiobasilic AVG) Tips and Troubleshooting References 23: Endovascular Creation of Arteriovenous Fistulas Introduction Ellipsys Equipment/Procedure Indications/Contraindications Prior Studies WavelinQ Equipment/Procedure Indications/Contraindications Prior Studies References 24: Surgical Management of Deep Fistula Veins Introduction Equipment for Basilic Vein Elevation Transposition (Fig. 24.2) Steps of Basilic Vein Elevation Transposition (Second Stage) Other Surgical Techniques for Superficialization of Deep Fistula Veins Tips and Troubleshooting References 25: Preoperative and Postoperative Care for Hemodialysis Vascular Access Surgery Introduction Preoperative Evaluation Equipment for Preoperative Evaluation Components of Preoperative Evaluation Postoperative Care Equipment for Postoperative Care Components for Postoperative Care Tips and Troubleshooting References Index