Chapter 56: Interventional Nephrology
Real-time ultrasound guidance for central venous catheter placement is
A. Not superior to landmark-based vein puncture
B. Not recommended due to extra equipment and time required to perform
C. Is recommended as “standard of care” for all central venous access procedures
D. Is only recommended when placing tunneled, long-term venous catheters
E. Is only recommended for jugular vein catheterization
The answer is C. US guided venipuncture is superior to landmark puncture; simple dedicated vascular US equipment is readily available in most U.S. centers, and its use does not add significant time or expense; guided venipuncture confers the same advantages for accessing any central vein, and for any catheter, tunneled, or nontunneled.
Stent grafts for treatment of stenosis at AV graft venous anastomosis
A. Have demonstrated advantage versus “bare-metal” stents
B. Improve lesion primary patency versus angioplasty alone
C. Increase graft secondary or cumulative patency
D. Should only be placed as a “last resort” in the setting of failed angioplasty
E. Should never be placed for forearm graft outflow across the elbow
The answer is B. Several studies have shown improved primary patency of the target lesion versus angioplasty; stent-grafts have never been compared with bare-metal stents “head-to-head”; no benefit has been demonstrated for secondary patency; studies have shown benefit as primary intervention, not just as salvage for failed angioplasty; the Viabahn stent-graft is approved for use across the elbow.
Coil embolization of fistula branch vein should be performed
A. For all branch veins arising from a native fistula
B. For collateral outflow veins in the presence of venous stenosis
C. When competing veins divert sufficient flow from the fistula to delay maturation or impair delivery of dialysis
D. To reduce fistula flow in setting of high-output cardiac failure
The answer is C. There is no rationale or evidence to support eliminating all vein branches; collateral veins provide necessary outflow in the setting of stenosis and should never be embolized; branch veins do contribute significantly to excessive flow in high-flow fistulae; there are some circumstances where branch vein ligation appears to be beneficial and should be performed, notwithstanding the lack ...