BackTable / VI / Podcast / Episode #139

AV Fistula & Graft Maintenance

with Dr. Ari Kramer

We talk with Vascular Access Surgeon Ari Kramer about AV Fistula and Graft Maintenance in dialysis patients from creation to long-term care, as well as tips and tricks for treating stenoses.

Sponsored by:

Medtronic Chameleon PTA Balloon Catheter
AV Fistula & Graft Maintenance with Dr. Ari Kramer on the BackTable VI Podcast)
Ep 139 AV Fistula & Graft Maintenance with Dr. Ari Kramer
00:00 / 01:04

BackTable, LLC (Producer). (2021, July 2). Ep. 139 – AV Fistula & Graft Maintenance [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Ari Kramer discusses AV Fistula & Graft Maintenance on the BackTable 139 Podcast

Dr. Ari Kramer

Dr. Ari Kramer is the Chairman of the Department of Surgery at Spartanburg Regional Healthcare System in Spartanburg, South Carolina.

Dr. Christopher Beck discusses AV Fistula & Graft Maintenance on the BackTable 139 Podcast

Dr. Christopher Beck

Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.

Show Notes

In this episode, vascular access surgeon Dr. Ari Kramer and our host Dr. Chris Beck discuss the creation, management, and salvage of AV fistulas and grafts.

Dr. Kramer describes the referral patterns that lead dialysis patients to his practice, citing the need to coordinate dialysis care around a common surgical practice. He works closely with nephrologists and dialysis centers to ensure quality of care and streamlined patient management. During an initial workup, Dr. Kramer includes a physical assessment and an echocardiogram to establish a baseline.

The doctors discuss the pros and cons of using AV fistulas versus grafts. While AV fistulas are autogenic and carry a lower risk of infection, there is a risk that these may not mature. On the other hand, AV grafts are fully matured but they carry a higher risk of infection and require a higher intervention rate. Dr. Kramer emphasizes the importance of understanding a patient’s cardiac performance and history before selecting a method of AV access. He also schedules periodic follow-up appointments to ensure that the access site reaches maturity, which is evaluated by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.

Dr. Kramer walks us through devices and procedures for angioplasty, stent placement, and drug coated balloon placement. Finally, he addresses strategies for managing re-stenosis and considerations for patient preferences regarding surgical revision.

Resources

Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Vascular Access: 2019 Update: https://www.ajkd.org/article/S0272-6386(19)31137-0/fulltext#secsectitle0720

American Society of Diagnostic and Interventional Nephrology (ASDIN): https://www.asdin.org/page/A2

Kidney Academy (use code “backtable21” for free access): https://www.kidneyacademy.com/

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Dialysis Access Procedure Prep

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