Interventionalist Education and Resources Outline

This page is a product of the Interventionalist Subcommittee of the Fistula First Breakthrough Initiative. The outline will be updated as new resources are identified and/or developed.

Goals

1. Acquaint interventionalists with patterns of failure in fistulae, as well as tools, techniques and outcomes for enhancing maturation, maintaining and restoring function to non-maturing, failing and clotted fistulae respectively.
    
2. Suggest criteria for appropriate use of interventions versus surgical alternatives.
    
3. Educate interventionalists about limiting catheter use and appropriate use of catheters.

    

•  Introduction: Creating AVF in all Eligible Hemodialysis Patients Fistula First Initiative (Video)
   
• Fistula First: National Vascular Access Improvement Initiative (Handout)

 

Introduction-importance of fistulae:
Fistula First Interventionalists: Getting Started (Video)
 

Anatomy of fistulae

Interventional Radiology in Fistulae: Introduction (Video)

• In situ (In progress - Check back soon)
   
• Transposed (In progress - Check back soon)
   
• Gracz (In progress - Check back soon)
   
• Exotic (In progress - Check back soon)
   

Patterns of failure of fistulae

Non-maturation 

• Assessment of the New AVF for Maturity (Video)
   
• Assessment of the New AVF for Maturity (Handout)
   
• Salvaging Immature Fistulae (Video)

Mature but failing fistulae
 

• Fistulography (Video)
   
• Assessment of the Mature AVF (Video)

Clotted fistulae

• Large vs. small to absent clot burden Fistulography (Video)

Non-maturation

Definitions

• Assessment of the New AVF for Maturity (Video)
   
• Assessment of the New AVF for Maturity (Handout)

Angioplasty

• Salvaging Immature Fistulae (Video)
   
• Endovascular Presentation of Immature and Dysfunctional AVF’s (Video)
   
• Endovascular Preservation of Immature Dysfunctional AVF’s (Handout)
   
• Non-Maturing Fistula Cases (Power Point)

Role of competing vessels (In progress - Check back soon)

• Embolization vs. ligation

Protocols, importance of limiting repeats, getting catheters out once mature, etc (In progress - Check back soon)

Evidence basis

• References: Immature Fistula

Surgical options (In progress - Check back soon)

 

Screening for fistula failure

• Screening (video)
   
• K/DOQI Vascular Access Guideline 5
   
• VAMP© Vascular Access Monitoring and Surveillance Flow Chart

Angioplasty of failing fistulae
 

PTA (Video)

Basic techniques (In progress - Check back soon)

Pharmacologic adjuncts (eg heparin, NTG) (In progress - Check back soon)

Endpoint determination (In progress - Check back soon)

Common complications and management (In progress - Check back soon)

Special Situations

• Cephalic Arch Stenosis (Power Point)
   
• Recommended Followup of Cephalic arch Lesions (Power Point)

Role of stents and covered stents

• Stents (Video)

Role of other adjuncts-cryo, cutting balloon, etc (In progress - Check back soon)

Post procedure management and follow-up (In progress - Check back soon)

Evidence Basis (In progress - Check back soon)

Surgical options (In progress - Check back soon)

 

Thrombolysis and thrombectomy of clotted fistulae
 

Patient selection-time from event, size of fistula, comorbidities, etc (In progress - Check back soon)

Techniques (In progress - Check back soon)

 

• Declotting (Video)
   
• Endovascular Recanalization of Thrombosed AVF’s (Video)
   
• Endovascular Recanalization of Thrombosed AVF’s (Handout)

Endpoint determination (In progress - Check back soon)

Tips and Tricks

• Purse String Suture (Power Point w/Video)
   
• Woggle Technique (Power Point w/Video)

Common complications and management (In progress - Check back soon)

Post procedure management and follow-up (In progress - Check back soon)

Evidence basis

• References: Fistula Declot

Surgical options (In progress - Check back soon)

 

Steal
 

Evaluation of steal

• Management of Steal Syndrome(Video)
   
• Management of Steal Syndrome (Handout)

Interventions for steal (In progress - Check back soon)

Evidence basis (In progress - Check back soon)

Surgical options

• Management of Steal Syndrome(Video)
   
• Management of Steal Syndrome (Handout)

Aneurysms/pseudoaneurysms
 

K/DOQI Vascular Access Guideline 5

Surgical options (In progress - Check back soon)

 

Catheters

Hazards of catheters

• Change Concept 7 AVF Placement in Patients with Catheters Where Indicated

Tunneled vs. Nontunneled (In progress - Check back soon)

Appropriate vessel choice (In progress - Check back soon)

Device choice (In progress - Check back soon)

Patient education at time of insertion (In progress - Check back soon)

Prompt removal when no longer needed (In progress - Check back soon)

• Track ALL Catheter Patients for Early Removal of Catheters
   
• Management of Patients with Central Venous Catheters Algorithm

Management of complications (In progress - Check back soon)

Evidence basis (In progress - Check back soon)

 

Ways of developing interdisciplinary collaboration “Process”

 (In progress - Check back soon)