Managing Dialysis Access
The number of patients with chronic kidney disease is increasing along with the number of patients requiring dialysis. The development and maintenance of vascular access is an extremely critical aspect of success and cost-effective management of these patients. In this month's issue, we have provided practical presentations of interest to all involved in vascular access issues, as well as a number of topical discussions on other endovascular matters.
Felicia B. Ricks, RD, CSR, LD, and Eric K. Peden, MD, review how the Kidney Disease Outcomes Quality Initiative and the Dialysis Outcomes and Practice Patterns Study have helped to improve care for end-stage renal disease patients. However, they question why many patients are left confused about their renal status, highlighting the importance of a strong dialysis care team and concluding that prevention is paramount.
In a roundtable discussion, Bart Dolmatch, MD, Jack Work, MD, and Ingemar Davidson, MD, PhD, address several topics in chronic dialysis including device selection, infection prevention and management, and treatment after a patient's vascular access options have been exhausted. Deborah J. Brouwer, RN, CNN, and Brian LaMendola, RN, BSN, then discuss the risks and complications of poor cannulation techniques. They further provide suggestions for access site preservation and treating AVG and AVF complications.
Dr. Dolmatch also reviews maintaining access with covered stents. He notes both AVFs and AVGs have high 1-year failure rates, but that covered stents show promise as a primary treatment option. His article is supplemented by an interview with Dr. Ziv J. Haskal, Principal Investigator of the recent FLAIR trial.
Scott S. Berman, MD, FACS, discusses the uncommon yet unfortunate complication of vascular-access–induced steal syndrome in the hemodialysis population. He presents causes of VASS and methods of preventing this challenging clinical problem. Scott R. Schultz, MD, and William D. McMillan, MD, share their firsthand experience of opening an ambulatory surgery center and how it compares to office-based practices for the management of dialysis access.
We are honored to once again share with you Dr. Zoltan G. Turi's annual vascular closure update. His insightful, thorough review is augmented with device charts, which include the closure and assisted compression devices currently available in the US.
Salem Almaani, MD; Dmitriy Feldman, MD; and Issam D. Moussa, MD, present us with a challenging case on the recanalization of an occluded popliteal artery using the retrograde approach. They note that it is important to attempt the antegrade approach first and that if endovascular treatment fails even after a retrograde attempt, surgery remains an option in appropriately selected patients. Our featured interviewee this month is Dr. Lars Norgren, who will lead the upcoming PAD 2009 meeting in Örebro, Sweden. He hopes that this meeting will bring together the vascular community throughout the world. He also discusses TASC II and the current state of those guidelines.
As always, we hope you will find this issue to provide you with timely and useful information to enhance your practice.