Options for tough situation

2. Options for tough situation
of
forearm HD Access
Jang-sang Park, M.D., PhD.
Division of Vascular & Endovascular Surgery
Department of Surgery
College of Medicine
The Catholic University of Korea
Seoul, Korea
AVF*, Arteriovenous fistula

3. 1. Introduction
2. AVF* : ( Basilic vein transposition)
3. AVF* : ( Cehalic vein transposition .
3. Conclusions
AVF*, Arteriovenous fistula
Options for tough situation
of
forearm HD Access

4. 1. Introduction
2. AVF* : ( Basilic vein transposition)
3. AVF* : ( Cehalic vein transposition .
3. Conclusions
AVF*, Arteriovenous fistula
Options for tough situation
of
forearm HD Access

5. 1. Introduction
2. AVF* : ( Basilic vein transposition)
3. AVF* : ( Cehalic vein transposition .
3. Conclusions
AVF*, Arteriovenous fistula
Options for tough situation
of
forearm HD Access

6. 1. Introduction
2. AVF* : ( Basilic vein transposition)
3. AVF* : ( Cehalic vein transposition .
3. Conclusions
AVF*, Arteriovenous fistula
Options for tough situation
of
forearm HD Access

7. 1. Introduction
2. AVF* : ( Basilic vein transposition)
3. AVF* : ( Cehalic vein transposition .
3. Conclusions
AVF*, Arteriovenous fistula
Options for tough situation
of
forearm HD Access

8. Hemodialysis dependent
5 – 8 % / yr
(2010 )
200 % ( 2 X )
?
USRDS 2003

9. Hemodialysis dependent
5 – 8 % / yr
(2010 )
200 % ( 2 X )
?
USRDS 2003

10. Hemodialysis dependent
5 – 8 % / yr
(2010 )
200 % ( 2 X )
?
USRDS 2003

11. Prevalence of ESRD

12. Prevalence of ESRD

13. ESRD
28,046
RT / 2522 (26.8%)
PD / 4671 (16.7%)
HD / 15853 (56.5%)
ESRD
63,341
RT / 13,051 (20.6%)
PD / 7694 (12.1%)
HD / 42,596 (67.2%)
2000 2011

14. ESRD
28,046
RT / 2522 (26.8%)
PD / 4671 (16.7%)
HD / 15853 (56.5%)
ESRD
63,341
RT / 13,051 (20.6%)
PD / 7694 (12.1%)
HD / 42,596 (67.2%)
2000 2011
2.6 times

15. ESRD
28,046
RT / 2522 (26.8%)
PD / 4671 (16.7%)
HD / 15853 (56.5%)
ESRD
63,341
RT / 13,051 (20.6%)
PD / 7694 (12.1%)
HD / 42,596 (67.2%)
2000 2011
2.6 times

16. ESRD
28,046
RT / 2522 (26.8%)
PD / 4671 (16.7%)
HD / 15853 (56.5%)
ESRD
63,341
RT / 13,051 (20.6%)
PD / 7694 (12.1%)
HD / 42,596 (67.2%)
2000 2011
2.6 times

17. ESRD
28,046
RT / 2522 (26.8%)
PD / 4671 (16.7%)
HD / 15,853 (56.5%)
ESRD
63,341
RT / 13,051 (20.6%)
PD / 7694 (12.1%)
HD / 42,596 (67.2%)
2000 2011
2.6 times
2.69 times

18. Prevalence of Hemodialysis (HD)

21. Strategy of long-term HD access

22. “ There is a dangerous potential for a surgeon
to exhaust
all the major access regions
unless
care is taken to preserve sites
for the future “
Kaugman JL , 1995
Strategy of long-term HD access

23. “ There is a dangerous potential for a surgeon
to exhaust
all the major access regions
unless
care is taken to preserve sites
for the future “
Kaugman JL , 1995
Strategy of long-term HD access

26. 38 Guidelines
8 Guidelines

27. AutogenousAutogenous AVF* ! !AVF* ! !
AVF*; Arteriovenous fistulaAVF*; Arteriovenous fistula

28. Radiocephalic AVF *
(wrist)
Failed ?
or
Unavailable ?
AVF*, Arteriovenous fistula

29. Radiocephalic AVF *
(wrist)
Failed ?
or
Unavailable ?
AVF*, Arteriovenous fistula

30. Radiocephalic AVF *
(wrist)
Failed ?
or
Unavailable ?
forearm
AVF*, Arteriovenous fistula

31. Radiocephalic AVF *
(wrist)
Failed ?
or
Unavailable ?
Brachial-antecubital looped graft
forearm
AVF*, Arteriovenous fistula

32. Radiocephalic AVF *
(wrist)
Failed ?
or
Unavailable ?
Brachial-antecubital looped graft
forearm
AVF*, Arteriovenous fistula

33. Radiocephalic AVF *
(wrist)
Failed ?
or
Unavailable ?
Brachial-antecubital looped graft
forearm upperarm
AVF*, Arteriovenous fistula

34. Radiocephalic AVF *
(wrist)
Failed ?
or
Unavailable ?
Brachial-antecubital looped graft
Brachial-cephalic AVF*
Brachial-basilic AVF*
forearm upperarm
AVF*, Arteriovenous fistula

35. Radiocephalic AVF *
(wrist)
Failed ?
or
Unavailable ?
Brachial-antecubital looped graft
Brachial-cephalic AVF
Brachial-basilic AVF
forearm upperarm
Autogenous vein
transposition (forearm
)
AVF*, Arteriovenous fistula

36. 1. Introduction
2. AVF* : ( Basilic vein transposition)
3. AVF* : ( Cehalic vein transposition .
3. Conclusions
AVF*, Arteriovenous fistula
Options for tough situation
of
forearm HD Access

37. Jan. 2002 Dec. 2012
82Pts
( 64 pts ; male )
(Average age : 62 years )

38. Jan. 2002 Dec. 2012
82Pts
( 64 pts ; male )
(Average age : 62 years )
29 pts (35.3 %)
Wrist AVF not avilable

39. Jan. 2002 Dec. 2012
82Pts
( 64 pts ; male )
(Average age : 62 years )
29 pts (35.3 %)
Wrist AVF not avilable
53 pts (64.7 %)
Failed

40. Jan. 2002 Dec. 2012
82Pts
( 64 pts ; male )
(Average age : 62 years )
29 pts (35.3 %)
Wrist AVF not avilable
53 pts (64.7 %)
Failed
Basilic vein trarnposition of forearm
F/U , 32.5 months (range 4 – 84 )

41. Charateristics n (%)
Mean age (years) 68.1 + 9.1
Sex (men) 52 ( 63)
Hypertension 41 (50)
Smoking 44 (54 )
CAD * 20 (24 )
Hyperlipidemia 12 (15)
DM ** 31 (38)
Renal transplant 3 (3 )
CAD *, coronary artery disease ; DM **, Diabetes mellitus
Patient characteristics

42. Charateristics n (%)
Mean age (years) 68.1 + 9.1
Sex (men) 52 ( 63)
Hypertension 41 (50)
Smoking 44 (54 )
CAD * 20 (24 )
Hyperlipidemia 12 (15)
DM ** 31 (38)
Renal transplant 3 (3 )
CAD *, coronary artery disease ; DM **, Diabetes mellitus
Patient characteristics

43. Comlications
14 (17%)
Edema 7 (8 %)
Aneury sm 4 (5%)
Infection 2 (2 %)
Stenosis 1 (1 %)

44. Results - 2
96 %
87 %
100
80
60
40
20
5 10 15 20 25 30 35
Months
Primary patency
Secondary patency

45. Cephalic vein
Basilic vein
Cephalic vein
Basilic vein

46. Basilic vein

47. Basilic vein

48. CASE 1

50. CASE 2

54. PTFE

66. 1. Introduction
2. AVF* : ( Basilic vein transposition)
3. AVF* : ( Cehalic vein transposition .
3. Conclusions
AVF*, Arteriovenous fistula
Options for tough situation
of
forearm HD Access

67. CASE 3

68. Cephalic vein
Cephalic vein

88. CASE 4

90. 1. Introduction
2. Autogenous AVF*
( Basilic vein transposition)
3. Conclusions
Basilic Vein Transposition
for
Another Forearm Autogenous *AVF

91. Conclusions - 1
1, HD-dependent population is increassing rapidly .
2, The survival rate of HD is significantly longer than PD*.
PD*, Peritoneal dialysis

92. Conclusions - 2
.
4, AVF on forearm with transposed
basilic or cephaoic vein have good
patency rate.
5, The complication rate is lower than
that reported of PTFE grafts, and most
related complications can be treated
conservatively without loss of the
fistula.
6, More efforts to make
autogenous AVF should be
emphasized.

93. Thank you !!!