VAS Young Committee

[VAS Young Committee @vasyoungcom]

An important message from dr. Lundström 📢 don't forgot the AVF after transplantation 📢. With suggestions when to Ligate⬇️

[VAS Young Committee @vasyoungcom]

s a summary, high flux AVF (>1.5L/min):
-⬇️carotid, renal, gut, capillaries and aortic flows
-⬆️coronary, cardiac output and pulmonary artery pressure.

As a result, a high-flux AVF can be dangerous in moderate-severe heart failure patients

[VAS Young Committee @vasyoungcom]

Dialysis access and the cardiovascular system, by Jan Malik
👀👉🏻 #VAS2025

[VAS Young Committee @vasyoungcom]

Porcine models made with ECMO cannulas, parameters such as O2, BP, tissue perfusion and flow were measured.

[VAS Young Committee @vasyoungcom]

Welcome to the #VAS2025 congress! This year, the young committee will also be present at these sessions. Come and join in!

[Raquel Barba Teba 🦋 @DrBarbaTeba]

The @vasyoungcom is present at the #VAS2025! See you all at the sessions coming this very day

[VAS Young Committee @vasyoungcom]

📢Article of the month📣 Interesting retrospective cohort study from Japan🤔! Showing that femoro-femoral arteriovenous fistulas can be a viable and durable option when traditional access points are no longer feasible!

https://t.co/cCE6OCQFc0

[VAS Young Committee @vasyoungcom]

The AVAS classification is a simple and validated method of describing VA options. However, it doesn't consider non-vascular anatomy related contraindications for access creation,and is only one part of a patient centred approach to VA in the haemodialysis population

[VAS Young Committee @vasyoungcom]

📣Article of the month 📢“The arteriovenous access stage (AVAS) classification” by Baláž et al. They report on a new classification system to describe a patient’s suitability and options for upper limb VA creation based on arterial and venous anatomy
https://t.co/qyzP7rNpC6

[VAS Young Committee @vasyoungcom]

➡️AVAS 2 patients are suitable for AV grafts, but unsuitable for native AV access. It is divided into 2 subgroups (A, B) which also correspond to the anatomic location (A – forearm, B – upper arm).
➡️AVAS 3 patients are not suitable for typical native or graft options.

[VAS Young Committee @vasyoungcom]

➡️Do not treat the venous stenosis as it could aggravate the distal ischaemia
➡️Cold hand without pain means the hand ischaemia is at grade I HAIDI
➡️Thus, conservative treatment and surveillance with no additional treatment if not aggravated during dialysis.

[VAS Young Committee @vasyoungcom]

📣Case of the month📣
Patient presents with some complaints of a cold hand, without pain, after creation of radiocephalic fistula (grade I Haemodialysis access-induced distal ischaemia (HAIDI).

[VAS Young Committee @vasyoungcom]

Ultrasound shows a central venous stenosis without venous hypertension (collapse of AVF with arm raising test) and a normal flow around 900 ml/min.
We also find an impaired dilatation of the distal arteries, narrowed and atheromatous.
What to treat????

[VAS Young Committee @vasyoungcom]

This patient also had significant central venous stenosis and previously underwent stenting and venoplasty of her central veins (black arrow, B)

[VAS Young Committee @vasyoungcom]

📣Case of the month📢
Complex access cases where patients have exhausted traditional upper limb options or have central venous disease still have vascular access options beyond central venous catheters or lower limb access ⬇️⬇️⬇️

[VAS Young Committee @vasyoungcom]

An ePTFE graft (white arrow, A) is anastomosed to the brachial artery, the outflow is connected to the venous outflow component (white arrow, B). The graft can be needled using standard needling techniques (C).

[VAS Young Committee @vasyoungcom]

Limitations
▶️ Single center with smaller number of patients wever,
▶️ Assumed normal cognition and cancer-free patients
▶️ Did not consider any laboratory data
▶️ Would have been interesting if compared to the KDOQI Life Plan, as changes in the patient examination may vary

[VAS Young Committee @vasyoungcom]

STRIKINGLY⚡️only 65% of AVFs were deemed mature prior to death versus 94% of AVGs p=0.03

🔔Suggesting AVG should be considered over AVF creation, if there is a short life expectancy 🔔