Dirk Hentschel

44 posts

Dirk Hentschel

Dirk Hentschel

@dialysisaccess1

Katılım Mayıs 2017
15 Takip Edilen158 Takipçiler
Dirk Hentschel retweetledi
Patrick Heindel, MD, MPH
Patrick Heindel, MD, MPH@PatrickHeindel·
Do you heparinize during AVF creation? Never, always, selectively? @jflucas3 @robshahverdyan @YuoTheodore @wasse_m @dialysisaccess1 @CKeithOzaki @KarenWooMD @SouthernVasc @VascularSVS
Mohamad A Hussain MD@ma_hussainMD

Congrats to @PatrickHeindel @BrighamSurgery @BrighamVascular @CSPH_BWH for his talk on using emerging #TargetTrial Emulation techniques to study the effect of heparin use on outcomes after #AVF surgery @SouthernVasc! #SAVS2023

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Dirk Hentschel
Dirk Hentschel@dialysisaccess1·
@pparikhxr @PenVascular impressive thrombus - if idea is that "flow" around TC reduces thrombus, consider this: SVC flow <25% CO, IVC flow > 65% CO, tip in hepatic IVC with good flow. - occlusion at IVC-RA junction difficult to cross/recanalize
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Pankit Parikh
Pankit Parikh@pparikhxr·
All tunn dialysis catheters MUST terminate in the right atrium. Even the ones that are femoral access. @PenVascular
Pankit Parikh tweet media
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Dirk Hentschel
Dirk Hentschel@dialysisaccess1·
@xaviervel Have you done an elective? That can give a lot of insights
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Dirk Hentschel
Dirk Hentschel@dialysisaccess1·
@pparikhxr Hmm, this is a subclavian vein port-a-cath, snapped off between clavicle and 1st rib, while unusual, this is a typical effect of long-term bone-on-bone stress can do...IJ port-a-cath?
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Pankit Parikh
Pankit Parikh@pparikhxr·
No one could have foreseen this...no one. Just thankful for the opportunity to snare.
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Monnie Wasse, MD, MPH
Monnie Wasse, MD, MPH@wasse_m·
50-ish pt w/ SEVEN right HeRO #AVG declots in 8 mo H/o: -Failed renal tx on HD -Failed PD -CAD, s/p CABG -Marked LV,LA, RA w/diffuse hypokenesis, TR & afib on coumadin -Chronic sbp 110 (pre-HD) on midodrine Time to CVC consign? If not, what?
Monnie Wasse, MD, MPH tweet media
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Monnie Wasse, MD, MPH
Monnie Wasse, MD, MPH@wasse_m·
4 month old interposition AVG from stump of RC-AVF to brachial vein. Angioplasty of proximal vein-AVG anastomosis for high VP’s. Access surgeons- how many of u do this config vs. revising the AVF ? Why/why not?
Monnie Wasse, MD, MPH tweet media
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Monnie Wasse, MD, MPH
Monnie Wasse, MD, MPH@wasse_m·
Case follow-up of recurrent thrombosis of L forearm brachial-brachial loop AVG.⚡️ Left arm SBP 112: R arm 105. Nl arteriogram- from subclavian to brachial inflow artery. @MageeCG @SaadTheodore @NMawlaMD @robshahverdyan @ASDINNews
Monnie Wasse, MD, MPH@wasse_m

Vexing problem ⚡️ Elderly pt w/ brachial-brachial loop #AVG w/ 5 thrombotic events in 4.5 mo. Stent extension 3 mo ago at OSH. - post HD bp ~ 110 - on ASA + Eliquis What would you do/try next?

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Dirk Hentschel
Dirk Hentschel@dialysisaccess1·
@SaadTheodore that is a good early result. - 3mm usually necessary for longer control, wall edema during case usually results in flow increase after 1-2 weeks; banding site closer to anastomosis (5-10mm) also seems to last longer..as you said easily repeated
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Theodore Saad
Theodore Saad@SaadTheodore·
Neat little case. Young woman on HD with ultra-high flow AVF (2.5 L/min), CHF, pulmonary hypertension. Minimally invasive, balloon assisted inflow banding. 15 minutes, local anesthesia, outpatient access center. "Mission accomplished?"
Theodore Saad tweet mediaTheodore Saad tweet mediaTheodore Saad tweet media
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Jefferson Peeples
Jefferson Peeples@NephroPeeps·
what dialysis access procedure/surgery is safe to undergo while on DAPT (Recent MI and must be on DAPT for 5 more months)? AVF creation, PD cath placement, minimally invasive AVF creation? Or do you place tunneled HD cath until off DAPT? #askrenal @askrenal @wasse_m
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Theodore Saad
Theodore Saad@SaadTheodore·
Got C-3 nerve root impingement Started Prednisone 60 mg Day-1: “I feel better than I did 20 yrs ago” Day-3: Mind racing, can’t focus or process Rx algorithm; irritable, annoying chatterbox Relieved myself from patient care: dangerous & irresponsible to continue True story
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Dirk Hentschel
Dirk Hentschel@dialysisaccess1·
@KingairDoc No symptoms, no treatment - vein likely will sclerose and will be lost as access site after catheter removal...mechanistically, if no flow, how will anticoagulation affect occlusive segment with great collaterals?
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Rick Mishler
Rick Mishler@nephaccsurg·
Hello vascular access geeks: 61 yo male. LIJ TDC (per pt request) x 4 mo. Asymptomatic limited (2-3 cm) LIJ thrombus noted during transplant evaluation. No known risk factors for hypercoag. HTN, CMO grade 2 diastolic dysfunctional w/ preserved LV fxn. Treatment plan?
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Monnie Wasse, MD, MPH
Monnie Wasse, MD, MPH@wasse_m·
Pt w/3 prior thrombotic AVG episodes in 17 days rx’d at outside clinic. 👉🏽 Found this odd-looking inflow juxta-anastomotic lesion. 👉🏽 Elastic so placed limited stent graft & salvaged the AVG. Surgeons- what does does this resemble? Kink/torsion?
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Keşfet

@jflucas3 @robshahverdyan @YuoTheodore @wasse_m @CKeithOzaki @SouthernVasc @VascularSVS @ASDINNews