DFW Vascular

We finished the year with 3 publications, and two more to come, to support our expertise in the treatment of complex venous occlusions to maintain the function of dialysis access in patients on hemodialysis! We are one of the few vascular groups in North Texas that provides complete care of patient's dialysis access: surgical creation of vascular access, evaluation and maintenance of function in our office based angiosuite, and open vascular and endovascular treatment of complex venous complications!

Two patients with failed left upper arm dialysis vascular access and axillary vein occlusion were catheter-dependent and were successfully treated using axillary vein stenting and new upper arm dialysis access placement. We successfully maintain dialysis access functioning in the non-dominant arm by "recycling" occluded veins instead of abandoning them.

We are slowly getting back to provide care to dialysis patients with complex central venous occlusion.
Two cases of HeRO graft implantation in patients that were catheter-dependent!

We treat complex venous occlusions with endovascular techniques that maintain the function of the hemodialysis patient dialysis vascular access and contribute to their well-being. We are committed to do everything we can to keep dialysis access in the upper extremities.
This is an example of cases we treat during a regular week.

43 y/o woman with left arm dialysis access and superior vena cava occlusion causing face and neck edema, shortness of breath, and inability to sleep flat on her back. She was treated successfully with SVC stenting!

55 year old smoker with severe leg pain, no pulses, no doppler waveforms both feet! Outpatient angiogram revealed occluded distal aorta! Successful revascularization with aorto-iliac angioplasty and stenting! Patient went home after procedure.

Reviewing superficial vein anatomy during open AV fistula case. In preparation for endovascular creation of arteriovenous fistula for hemodialysis access using Bard Wavelink device. New technique to benefit our patients soon.

DFW Vascular Group will be represented at the 47th Symposium of the Society of Clinical Vascular Surgery in Boca Raton, Florida. March 16-20, 2019.

This patient had a left chest wall dialysis access and superior vena cava occlusion treated with bypass to right atrium in 2012. She lost the dialysis graft to infection in September 2018 and now has undergone new left arm dialysis vascular graft placement. Superior vena cava bypass graft is still patent!!

54 y/o male with recent left arm dialysis fistula suffering from complications of left innominate vein occlusion was treated with stenting.
Office-based angioplasty and stenting of central veins in dialysis patients at DFW VASCULAR.

50 y/o woman with left arm dialysis access and superior vena cava occlusion. Successfully treated with superior vena cava stenting at our office-based angiosuite!

Our mini “Hybrid endovascular suite”!!!
Dialysis fistula banding to treat arterial steal. From 11 mm to 5 mm, confirmed with intravascular ultrasound.

Patient with bilateral brachiocephalic vein occlusion and failing dialysis graft in leg.
Our plan: Inside-out wire to right neck/HeRO conduit to atrium/Right arm dialysis graft

This patient in need of upper extremity dialysis access has right brachiocephalic vein and left subclavian vein occlusion, and left brachial artery occlusion.
Management included:
1. Inside-out recanalization of vena cava from femoral vein to place a temporary dialysis catheter in the right neck.
2. HeRO conduit to bypass left subclavian occlusion and connect it to a dialysis graft in the arm.
3. Brachial artery bypass to provide arterial inflow to the dialysis graft.
At DFW Vascular, we use aggressive techniques to maintain or create upper extremity dialysis access.

Dr. Pablo V. Uceda and Vascular Lab Director Amanda Combs discussed Peripheral Arterial Disease this afternoon at DocTalk live!
Thank you Drs. Sri Venkataraman, Dr. Chaudhry, and Dallas Renal Group for the invitation!

DFW Vascular, experts in treating central vein occlusion. This week we treated successfully dialysis patients with central vein occlusion to maintain function of their dialysis vascular access. We used open vascular and endovascular techniques.

At DFW Vascular, we are experts in treating central vein stenosis in dialysis patients. This patient had superior vena cava syndrome and severe bilateral arm edema caused by bilateral subclavian and innominate vein stenosis and superior vena cava stenosis. She had a left arm dialysis access. She was treated with right first rib resection and stenting of right subclavian vein, bilateral innominate veins, and superior vena cava. A HeRO conduit was placed through the SVC stent and attached to the left arm access to preserve function.

Another case of a clotted right upper arm dialysis vascular access compromised by subclavian vein compression/stenosis treated with right first rib resection and immediate vein stenting to salvage the access! We are a few in the DFW Metroplex that offer this treatment to dialysis patients!

DFW Vascular Surgeons Samuel Ahn, Robert Feldtman, and Pablo Uceda gave presentations this afternoon at the 33rd meeting of the Texas Vascular and Endovascular Society in Dallas.

Three DFW Vascular Group surgeons will represent us at Texas Society for Vascular and Endovascular Surgery (TSVES)
33rd TSVES Annual Meeting
November 3 – 4, 2017
The Crescent Hotel & Spa, Dallas,
Dr. Samuel Ahn
Dr. Robert Feldtman
Dr. Pablo V. Uceda

First use of drug eluting balloon to treat dialysis fistula stenosis in Dallas. Treatment of in-stent stenosis with Lutonix balloon at Methodist Medical Center.

This patient could not have a central venous catheter using conventional techniques due to occluded veins in the right side and superior vena cava (SVC) stenosis treated with a stent and presence of a dialysis catheter from the left side. We used the inside-out technique from a femoral vein to SVC approach (nurses call it "body floss") to place a mediport catheter from the right neck.

Another inside-out Superior Vena Cava (SVC) recannalization in a 50 y/o woman on dialysis for more than 25 years who was undergoing dialysis via a femoral catheter for the past year because of SVC occlusion that precluded a dialysis access in the upper extremities. We were able to place a right upper arm dialysis graft! We are the only group in the DFW metroplex offering this procedure!

Dr. Peter Lin presents experience of 10,000 outpatient endovascular procedures. Combined effort of University Vascular Associates in LA and DFW Vascular Group in Dallas.
Outpatient Endovascular Interventional Society meeting.

Dr. Sam Ahn presents how to set up an office based angiosuite at the Outpatient Endovascular Interventional Society meeting.

Providing care at the office all day today. Endovascular procedures and vascular clinic!

From the New England Journal of Medicine, September 16, 2016
"Hospitalists and the Decline of Comprehensive Care"
The reality is that medicine can be practiced without hospitals, but hospitals can not function without physicians. ..the hospital itself is ultimately a tool without which patients can still be given care. The true core of good medicine is not an institution but a relationship - a relationship between two human beings.

Pablo V Uceda MD

50 y/o woman with left arm dialysis fistula and central vein stenosis causing left arm, neck and face edema! Succesful treatment with inside-out retrograde recanalization of superior vena cava to left neck, antegrade HeRO conduit placement to left arm cephalic fistula to preserve dialysis access!

66 y/o patient with left arm dialysis access and severe arm edema caused by subclavian vein occlusion. Successful treatment with left first rib resection followed by subclavian vein stenting!
Drs. Robert Feldtman and Pablo V Uceda, treat complex central vein occlusions to preserve upper extremity dialysis access!

Treatment of central vein occlusion using transeptal needle and "inside-out-technique" and HeRO conduit placement to preserve left arm dialysis access.

Dr. Samuel Ahn And Dr. Pablo V. Uceda presentations have been accepted at one of the most prestigious vascular meeting in the US, Veith Symposium.

Surgeons at DFW Vascular Group treat subclavian steal syndrome. Subclavian artery stenosis/occlusion create retrograde flow in the vertebral artery with ipsilateral arm exercise causing symptoms of dizziness and near syncope.
Our surgeons diagnose and treat this condition with endovascular techniques and if not feasible with open vascular procedures such carotid artery to subclavian bypass. The procedure presented below took one hour. Dr. Feldtman.

September is Peripheral Artery Disease (PAD) Awareness Month! PAD is a chronic circulatory condition that affects 18 million US citizens. If left untreated, PAD leads to unnecessary limb amputations. The surgeons at DFW Vascular diagnose and treat PAD in hundreds of patients each year, saving limbs and saving lives!

Know the symptoms...
**Leg pain when walking
**Muscle pain or cramping in legs and calf triggered by activity
**Leg numbness or weakness
**Coldness on lower leg or foot
**Sores on toes, legs or feet that won't heal
**Change in color of legs

Call today at 1-855-LEG-HURT or 214-946-5165 to make an appointment with one of the DFW Vascular Group surgeons to receive your PAD evaluation.

DFW Vascular Group surgeons Robert Feldtman and Pablo V Uceda use aggressive reconstructive endovascular techniques in patients with superior vena cava occlusion to preserve the function of upper extremity dialysis vascular access.