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Chapter 56: Interventional Nephrology

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Real-time ultrasound guidance for central venous catheter placement is

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A. Not superior to landmark-based vein puncture

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B. Not recommended due to extra equipment and time required to perform

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C. Is recommended as “standard of care” for all central venous access procedures

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D. Is only recommended when placing tunneled, long-term venous catheters

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E. Is only recommended for jugular vein catheterization

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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.

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Stent grafts for treatment of stenosis at AV graft venous anastomosis

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A. Have demonstrated advantage versus “bare-metal” stents

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B. Improve lesion primary patency versus angioplasty alone

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C. Increase graft secondary or cumulative patency

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D. Should only be placed as a “last resort” in the setting of failed angioplasty

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E. Should never be placed for forearm graft outflow across the elbow

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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.

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Coil embolization of fistula branch vein should be performed

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A. For all branch veins arising from a native fistula

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B. For collateral outflow veins in the presence of venous stenosis

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C. When competing veins divert sufficient flow from the fistula to delay maturation or impair delivery of dialysis

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D. To reduce fistula flow in setting of high-output cardiac failure

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E. Never

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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 ...

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