ESRD treatments

[irwarrior]

Growing role of vascular interventional radiologists in the management of the ESRD population.


1) Increasing placement of peritoneal dialysis catheters percutaneously with local anesthesia and sedation in the interventional suites (patients can do this at home on a daily basis)
2) Placement of tunneled dialysis catheters in patients who have AKI or who do not want an av fistula or graft
3) Maintenance of dialysis fistulas and grafts (declotting grafts and fistulas). Identifying malfunctioning grafts/fistulas
4) Newest kid on the block is the actual percutaneous creation of av fistulas (there are currently 2 FDA approved devices)
-one that uses heat based energy to create an artery to vein connection usually between the cephalic vein through the perforator Into the proximal radial artery
-The other that uses RF via two magnets in the radial artery to radial vein or ulnar artery to ulnar vein

Pretty exciting options for this challenging population.

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[br9]

Is IR the main provider on these interventions? Are turf wars with interventional nephrology and vascular surgery a huge problem?

 

[NDcienporciento100]

Is IR the main provider on these interventions? Are turf wars with interventional nephrology and vascular surgery a huge problem?

Plenty to go around

 

[NDcienporciento100]

Growing role of vascular interventional radiologists in the management of the ESRD population.


1) Increasing placement of peritoneal dialysis catheters percutaneously with local anesthesia and sedation in the interventional suites (patients can do this at home on a daily basis)
2) Placement of tunneled dialysis catheters in patients who have AKI or who do not want an av fistula or graft
3) Maintenance of dialysis fistulas and grafts (declotting grafts and fistulas). Identifying malfunctioning grafts/fistulas
4) Newest kid on the block is the actual percutaneous creation of av fistulas (there are currently 2 FDA approved devices)
-one that uses heat based energy to create an artery to vein connection usually between the cephalic vein through the perforator Into the proximal radial artery
-The other that uses RF via two magnets in the radial artery to radial vein or ulnar artery to ulnar vein

Pretty exciting options for this challenging population.

I fistula work in particular to be fun procedures.

 

[Kuratz]

@irwarrior

Thanks for the nice ESRD rundown.

Very exciting to see where percutaneous fistula creation goes in the next few years.

Also didn't realize PD caths were being placed by IR under local. That's awesome. Do you remove them as well?

Advances like this are why IR is such an awesome field.

 

[irwarrior]

Yes. The PD catheter removal is pretty straightforward. Cutdown to the cuffs, dissect them out and remove.

If you do not have an office to evaluate and manage the conditions of the patients with ESRD you treat and a place to follow these patients, it is difficult to provide quality care for this vulnerable population. Dialysis patients need good follow up and education on how to evaluate their own fistula etc. The dialysis nurses need education on how to safely cannulate the fistulas especially the percutaneously created AVF.

They dialysis patients also may have peripheral vascular disease and may need arterial revascularization as they develop non healing wounds. So it is important to monitor all of these conditions in these patients.