May 02
HeRO Grafts require 5 times as many interventions as thigh fistulas to maintain patency

HeRO grafts require 5 times as many interventions as thigh fistulas in order to maintain patency. This is one of the astounding findings of our article comparing HeRO grafts to Femoral vein fistulas (Superfical Femoral artery to transposed Femoral Vein).

Read the article hereJVA-D-16-00234 Hero Grafts and Thigh Fistulas.pdf

Jul 20
Mission Linen: Poor Service and 8% price increase

LDAC's relationship with Mission Linen is ending. 

 Among our concerns:

1.      An approximately 8% annual increase in prices in December 2015 is very high

2.      Problems with deliveries; items missing

3.      Invoices not always properly reflecting what was delivered

4.      Scrubs: invoice does not reflect inventory by size, so what is being used/delivered is unknown

5.      No electronic receipts for our Visalia location from May – mid-July, until after our meeting during which I again requested receipts

​ LDAC is open to proposals from other linen companies.


Jul 14
Results of LDAC's hard work in the REVISE trial have finally been published

Results of the REVISE trial of balloon angioplasty versus stent graft in failing or thrombosed dialysis grafts have finally been published in Journal of Vascular Surgery.  LDAC Vascular Centers was one of Principal Investigators and LDAC was among the highest enrollers in this multicenter trial. Link to Journal of Vascular Surgery

Jul 12
Assistance Sought from Central California Alliance for Healthcare in Resolving unpaid CCAH claims

LDAC Vascular Centers now has ​4 times as many unpaid claims as paid claims from Central California Alliance for Healthcare. Most of these have involved patients referred by their nephrologist for services which the Plan does not acknowlege because the plan's referral procedures were not followed.

We have sought the assistance of CCAH in resolving these issues.  While these issues are being resolved we are sorry but we will not be able to accept referrals of new patients for whom CCAH insurance is primary.

Patients with CCAH insurance as their secondary insurance are exempt from these restrictions and will be accepted.  Pursuance to SB 137 the Plan was notified of this today.

May 16
Now appearing in print: Ladenheim's Hemaclear Tourniquet research cited by Bourquelot

​Dr. Pierre Bourquelot from the Angioaccess Surgery Department, Cliniqe Jouvent, Paris, France has cited Dr. Ladenheim's research in his article on a Narrow elastic disposable tourniquet (Hemaclear) vs traditional wide pneumatic tourniquet for creation or revision of hemodialysis angioaccesses.  Dr. Ladenheim provided the first report on the use of the elastic exsanguination tourniquet in angioaccess surgery.

Read Dr. Bourquelot's article hereJVA-D-15-00292 bourquelot.pdf

See Dr. Ladenheim's original article here: A sterile elastic exsanguination tourniquet is effective in preventing blood loss during hemodialysis access surgery.pdf

May 04
Patency of Femoral Vein Fistula is significantly greater than with the HeRO graft

Our Most significant Presentation at VASA this year invoved a comparison of the HeRO graft and the Femoral vein transposition fistula

.Introduction: For patients with bilateral upper extremity central venous

stenosis, AV access solutions can include the Hemodialysis Reliable Outflow

(HeRO) device as well as an autogenous AV fistula in the lower limb. We report

on a single surgeon experience with 40 HeRO grafts and 18 transpositions

of the femoral vein.

Methods: This is a retrospective analysis of 40 patients who underwent

placement of an upper extremity HeRO device and 18 patients undergoing

superficial femoral artery to transposed femoral vein AVF from 2009-to 2015

by a single surgeon at one center. Operative details, Intraoperative flows and

flows on the first week postoperative visit were recorded. Data was collected

on primary and secondary patency and intervention rates. Complications

were summarized by cross tabulation and compared between the HeRO and

SFA-tFV groups.

Results: The one year cumulative primary patency of the HeRO grafts was

30% and for the SFA-tFV fistulas was 79%, the difference was statistically significant

by Log Rank testing (p = .0001). The one year cumulative secondary

patency was 71% for the HeRO grafts and 93% for the SFA-tFV fistulas, also a

statistically significant difference (p = .03). The HeRO graft patients required

an average of 2.1 interventions per year to maintain patency. The thigh fistulas

required an average of 0.4 interventions per year to maintain patency.

37 out of 58 patients experienced a complication. There were significant differences

between the groups in patterns of complications. 37% of the tFV

patients had a hematoma or seroma compared with 5% of the HeRO graft

patients and 17% of the tFV patients experienced delayed wound healing

compared with 2.5% of the HeRO graft patients. (p<.05). None of the tFV

patients had distal ischemia.

Conclusions: HeRO graft had lower primary and secondary patency compared

with the transposed femoral vein fistula and HeRO grafts required

5-fold more frequent interventions to maintain secondary patency. However,

the patients with Femoral Vein transposition had significantly more problems

with healing of the surgical site. The tFV AVF has become our access of choice

for patients with bilateral central venous stenosis.


HeRO grafts compared with thigh fistulas.pdf 

May 04
Many Patients can Tolerate having Two fistulas in one Arm at the Same Time

Dr. Ladenheim presented from the podium ​Placement of secondary Fistulas in the ipsilateral extremity without ligation of the primary failing access at the Vascular Access Society of the Americas meeting in Chicago Illinois and Dr Lum presented the study during the poster session.  The study was was controversial.  The key finding was that when secondary fistulas were placed in the ipsilateral arm without ligation of the failing primary fistula, about one patient in three required ligation of the primary access because of arterial insufficiency.  The study was controversial.  Some throught it was an innovative solution to a commonly faced problem but the moderator,  Dr. Eric Peden, advised caution for medical-legal reasons because the frequency of arterial insufficiency found was higher much higher than than in primary fistulas.Double fistulas.pdf

May 03
A Pitfall to Avoid in Distal Radial Artery Ligation for Dialysis Access Associated Steal Syndrome

When wrist fistulas (Radiocephalic fistulas) get arterial insufficiency it is often associated with reverse flow in the radial artery distal to the fistula (distal with respect to the extremity).   This can be managed by distal radial artery ligation.  But you must make sure you ligate the radial artery close to the fistula.  One pitfall is too ligate it too close to the hand leaving a side branch intact. Dzenan Lulic, Raha Borzani, and Eric Ladenheim presented this poster at the Vascular Access Society of the Americas Meeting in Chicago on 5/3/2016.   


Apr 28
Grand Rounds at Kaweah Delta Hospital 4-28-2016

At Grand Rounds at Kaweah Delta Hospital in Visalia California Dr. Ladenheim explained how in recent years the Incidence of Dialysis-dependent Chronic Kidney Disease has been dropping but the Prevalence has been rising!   Preventative measures have been working and fewer people are getting end stage renal disease and the ones who get it are living longer.  See all the details in the attached presentation:  Hemodialysis and Peritoneal Dialysis Access.pdf

Apr 06
My Vision for Vascular Access Society of the Americas

​While I was at the recent September 2015 NIH conference on dialysis access, I was dismayed to find there was not any involvement by VASA board members in the reporting of the Hemodialysis Fistula Maturation study.  After the presentations, there were NIH workshops on research priorities, and unfortunately, VASA was not formally represented in the discussions.  I want VASA to speak for the dialysis access community and advise NIH on what we think the priorities should be in funding dialysis access research.   I will support having workshops on research priorities during our meetings and having the Board present these to NIH on behalf of the society.

Our society has opportunities for industry sponsorship, we need to reach out to industry and educate them about VASA being the best venue in the Americas to showcase new equipment and technologies.  I strongly suggest we leverage our industry contacts to advance the field of dialysis access.

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