John F Lucas III

Surgeon in Greenwood, MS with a passion for dialysis access surgery

[John F Lucas III @jflucas3]

Unique opportunity for hands-on learning in all aspects of dialysis access. See and use all the cutting edge technology at biannual VASA Practicum.
https://t.co/glh6ZcaqlJ
https://t.co/QcN63Ob9Gz

[John F Lucas III @jflucas3]

@robshahverdyan @VascularNews @SocietyAccess @Vascupedia_com @VASBImedia @VASAMD @Evc2022 @Renal_Ints Congratulations!! This will truly be a center of excellence for dialysis access.

[John F Lucas III @jflucas3]

@wasse_m Graft could be cannulated but would result in a nearly 180 degree turn for the catheter. Sticking the radial artert in a brachial based graft has a higher risk of radial artery thrombosis due to lower radial artery flow. Best option is to find an artery in another extremity.

[John F Lucas III @jflucas3]

Proximal radial artery cephalic fistula placed in 2013. Only 2 interventions in 13 years. Last one 2 weeks ago for cephalic arch stenosis. Have scheduled for banding for flow ~1800 ml/min.

[John F Lucas III @jflucas3]

Radiocephalic fistula created in 2012. Has had 2 interventions. Now with severe stenosis at the elbow. Plan to repair aneurysms, tunnel fistula in new location and connect to basilic vein for outflow.

[John F Lucas III @jflucas3]

Don't miss the 2024 VASA Hemodialysis Symposium, May 16-18, 2024 at the Hyatt Regency Atlanta in Atlanta, Georgia. Great opportunity to learn about the latest in access surgery, meet the experts and share your experience.
Register now at https://t.co/LgjEAd3XXs

[John F Lucas III @jflucas3]

@KingairDoc Have done twice with good results when banding of vein near anastomosis has returned with high flows months later. Palmar arch must be patent and provides increased resistance over a longer length.

[John F Lucas III @jflucas3]

@TransplantSrgn Company went out of business due to high cost of providing support when the one person who knew how to easily cannulate the device left and they had to go back at no reimbursement and train someone else.

[John F Lucas III @jflucas3]

2 VWings placed in 2015. Used until 3 months ago. Patient has had large weight loss and the VWings were protruding and vein is now easy to cannulate in several locations. No evidence of aneurysm after needling in same spot for almost 9 years

[John F Lucas III @jflucas3]

@robshahverdyan Patient had lost about 70 lbs, and VWings were protruding above the skin. Due to weight loss other segments of the vein were easy to cannulate since they were no longer deep.

[John F Lucas III @jflucas3]

@NMawlaMD @ASDINNews @RenalFellowNtwk @wasse_m @robshahverdyan @SaadTheodore @YuoTheodore @PharaohofAccess Declot surgically under local and send for dialysis. If unable to get dialysis same day, check labs to determine if oral hypokalemia therapy is needed.

[John F Lucas III @jflucas3]

@MeloneyOliveira @wasse_m If any access has 3L/min flow it needs to have a flow reduction procedure regardless of the echo results.

[John F Lucas III @jflucas3]

@rafaelvascular @VarenyamVasc @VascularSVS @Kuldeep1926 @JVSVL @JVascSurgCIT Difficulty with cannulation, risk of rupture. If heavily calcified can revise and remove calcium similar to endarterectomy. Need to determine why aneurysm developed and correct the cause. High flow, outflow stenosis, cluster cannulation. Often is a combination of all three

[John F Lucas III @jflucas3]

@VarenyamVasc @VascularSVS @Kuldeep1926 @JVSVL @JVascSurgCIT Dissect out the lower two thirds of the fistula, discard the redundant vein, reduce the size of the aneurysms, tunnel laterally under new skin and either reanastomosis with banding or distalize to the proximal radial to control excessive flow

[John F Lucas III @jflucas3]

@rportiolli @wasse_m @robshahverdyan @NMawlaMD @rsharaf67 @ASDINNews Compress fistula at anastomosis to reduce flow. If this results in elimination of the pulsatility and preservation of a good thrill, I would do flow reduction with a goal of ~ 600-800 ml/ min.

[John F Lucas III @jflucas3]

@mattsmeds @wasse_m Only see the patient back if they are referred by the dialysis clinic for a problem. Do call annually for follow up. Clinic visits without an indication would only add cost and a recommendation to avoid area cannulation - advice which is only followed for a short time.

[John F Lucas III @jflucas3]

@wasse_m @robshahverdyan @ASDINNews @NMawlaMD @VASBImedia @VASAMD @SunghoLim @nick_inston Would not rely only on venogram for mapping. Dye may not show all veins. Need to look for superficial veins using ultrasound with tourniquet, dependent and with exercise. You will often see veins not visualized by venogram.

[John F Lucas III @jflucas3]

@wasse_m @robshahverdyan @ASDINNews @NMawlaMD @VASBImedia @VASAMD @SunghoLim @nick_inston Brachio-brachial fistula in 2 stages. Create the anastomosis at or just above the elbow. Superficialize in 1-2 months when vein is ~ 6 mm or larger

[John F Lucas III @jflucas3]

@wasse_m @ASDINNews @NMawlaMD @RenalFellowNtwk @VASBImedia @robshahverdyan Need to share this problem with the surgeon who created it so he/she can do better next time.
Agree with establishing button holes.