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Posted By Jeffrey Hoggard,
Tuesday, March 3, 2026
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To ASDIN Officers, Councilors, the Membership and Mary Lea and staff: I want to express my sincere thanks for the Lifetime Achievement Award given to me at ASDIN 2026 annual meeting in Orlando last weekend. Bharvi Oza-Gajera offered me the chance to speak at the podium but I declined out of respect for keeping the meeting on time; I hope the program chairs appreciate this consideration. Please indulge me now to let you know that this award is greatly appreciated at my retirement. ASDIN is a wonderful community of professionals dedicated to the “lifeline” of our patients. This award is a high honor for me. I remain hopeful that the current low numbers of new nephrologists are just a cycle and that we continue to encourage and inspire the young and bright future talent that our specialty is rewarding in many ways. Godspeed ASDIN. Jeffrey Hoggard MD
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Posted By Jeffrey Hoggard,
Tuesday, March 3, 2026
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To ASDIN Officers, Councilors, the Membership and Mary Lea and staff: I want to express my sincere thanks for the Lifetime Achievement Award given to me at ASDIN 2026 annual meeting in Orlando last weekend. Bharvi Oza-Gajera offered me the chance to speak at the podium but I declined out of respect for keeping the meeting on time; I hope the program chairs appreciate this consideration. Please indulge me now to let you know that this award is greatly appreciated at my retirement. ASDIN is a wonderful community of professionals dedicated to the “lifeline” of our patients. This award is a high honor for me. I remain hopeful that the current low numbers of new nephrologists are just a cycle and that we continue to encourage and inspire the young and bright future talent that our specialty is rewarding in many ways. Godspeed ASDIN. Jeffrey Hoggard MD
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Posted By Marc Webb,
Friday, October 31, 2025
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"Using a dirty wire" Long and short, working in a new hospital as a corporate employee after closing my practice, getting used to a new environment, unfamiliar staff, different assortments of balloons, wires, grafts, suture, drains - the whole man-from-the-moon routine. One of my first cases was a patient I'd known since 2005 who managed to get her graft removed for infection during my 9 month transition period. With the left side healing and out for the short-term at least, I planned a right arm fistula or graft depending on intraoperative ultrasound and venography. Ultrasound demonstrated a played-out cephalic vein, but a reasonable median antecubital/ basilic system over 5mm. I put in a sheath, and found a nice basilic vein up to the axillary, where it disappeared into a tangle. Not to be deterred, I worked a Kumpe catheter up by slow degrees using a 40 cm destination long sheath, recanalizing the axillary, subclavian, and right innominant clear to the SVC. This process took over an hour. Dilated with a 4mm low-profile balloon (the only thing that would pass), then an 8mm balloon. The result was a very ratty channel ruptured somewhere in the upper axillary vein without much progression of injected dye flow. "Must place stent". Now here is the problem - Viabahn stents available in this OR are only in a 0.018 wire platform, and the only 0.018 wire is 260 cm long. We place the wire, then remove the exchange catheter. In the process, the long 0.018 wire slumps off the upper side of the arm board and OR table - not to the ground I thought, but below the drape "skirt" and it is "contaminated", according to the vigilant C-arm operator. If I pull the wire, I am fairly sure I will never be able to pass through the damaged territory again, especially with a ruptured axillary vein, and I will either have to lose this opportunity to place a right arm access, wait a long time for the other arm to heal, plan a femoral graft, or keep the patient on a permacath. Or I can wipe the wire. I thought the risk of actual infection was very low - the patient had received Vanco, and I wiped the wire with a saline 4 x 4, then a dilute betadiene solution, then saline again. The moment I passed another catheter to the central end of my obstruction we pulled and discarded the wire, but the damage was done - I had used a "dirty wire" in the mind of whoever submitted the criticism. So what would a "prudent operator" do in this unfortunate situation? I have already asked for a shorter 0.018 wire.
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Posted By Marc Webb,
Friday, October 31, 2025
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"Using a dirty wire" Long and short, working in a new hospital as a corporate employee after closing my practice, getting used to a new environment, unfamiliar staff, different assortments of balloons, wires, grafts, suture, drains - the whole man-from-the-moon routine. One of my first cases was a patient I'd known since 2005 who managed to get her graft removed for infection during my 9 month transition period. With the left side healing and out for the short-term at least, I planned a right arm fistula or graft depending on intraoperative ultrasound and venography. Ultrasound demonstrated a played-out cephalic vein, but a reasonable median antecubital/ basilic system over 5mm. I put in a sheath, and found a nice basilic vein up to the axillary, where it disappeared into a tangle. Not to be deterred, I worked a Kumpe catheter up by slow degrees using a 40 cm destination long sheath, recanalizing the axillary, subclavian, and right innominant clear to the SVC. This process took over an hour. Dilated with a 4mm low-profile balloon (the only thing that would pass), then an 8mm balloon. The result was a very ratty channel ruptured somewhere in the upper axillary vein without much progression of injected dye flow. "Must place stent". Now here is the problem - Viabahn stents available in this OR are only in a 0.018 wire platform, and the only 0.018 wire is 260 cm long. We place the wire, then remove the exchange catheter. In the process, the long 0.018 wire slumps off the upper side of the arm board and OR table - not to the ground I thought, but below the drape "skirt" and it is "contaminated", according to the vigilant C-arm operator. If I pull the wire, I am fairly sure I will never be able to pass through the damaged territory again, especially with a ruptured axillary vein, and I will either have to lose this opportunity to place a right arm access, wait a long time for the other arm to heal, plan a femoral graft, or keep the patient on a permacath. Or I can wipe the wire. I thought the risk of actual infection was very low - the patient had received Vanco, and I wiped the wire with a saline 4 x 4, then a dilute betadiene solution, then saline again. The moment I passed another catheter to the central end of my obstruction we pulled and discarded the wire, but the damage was done - I had used a "dirty wire" in the mind of whoever submitted the criticism. So what would a "prudent operator" do in this unfortunate situation? I have already asked for a shorter 0.018 wire.
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Posted By Marc Webb,
Friday, October 31, 2025
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Long and short, working in a new hospital as a corporate employee after closing my practice, getting used to a new environment, unfamiliar staff, different assortments of balloons, wires, grafts, suture, drains - the whole man-from-the-moon routine. One of my first cases was a patient I'd known since 2005 who managed to get her graft removed for infection during my 9 month transition period. With the left side healing and out for the short-term at least, I planned a right arm fistula or graft depending on intraoperative ultrasound and venography. Ultrasound demonstrated a played-out cephalic vein, but a reasonable median antecubital/basilic system over 5mm. I put in a sheath, and found a nice basilic vein up to the axillary, where it disappeared into a tangle. Not to be deterred, I worked a Kumpe catheter up by slow degrees using a 40 cm destination long sheath recanalizing the axillary, subclavian, and right innominant clear to the SVC. This process took over an hour. Dilated with a 4mm low-profile balloon (the only thing that would pass), then an 8mm balloon. The result was a very ratty channel ruptured somewhere in the upper axillary vein without much progression of injected dye flow. Must place stent. Now here is the problem - Viabahn stents available in this OR are only in a 0.018 wire platform, and the only 0.018 wire is 260 cm long. We place the wire, then remove the exchange catheter. In the process, the long 0.018 wire slumps off the upper side of the arm board and OR table - not to the ground I thought, but below the drape "skirt" and it is "contaminated", according to the vigilant C-arm operator. If I pull the wire, I am fairly sure I will never be able to pass through the damaged territory again, especially with a ruptured axillary vein, and I will either have to lose this opportunity to place a right arm access, wait a long time for the other arm to heal, plan a femoral graft, or keep the patient on a permacath. Or I can wipe the wire. I thought the risk of actual infection was very low - the patient had received Vanco, and I wiped the wire with a saline 4 x 4, then a dilute betadiene solution, then saline again. The moment I passed another catheter to the central end of my obstruction we pulled and discarded the wire, but the damage was done - I had used a "dirty wire" in the mind of whoever submitted the criticism. So what would a "prudent operator" do in this unfortunate situation? I have already asked for a shorter 0.018 wire.
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Posted By Abigail Falk,
Wednesday, August 13, 2025
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Posted By Abigail Falk,
Wednesday, August 13, 2025
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Posted By Abigail Falk,
Wednesday, June 18, 2025
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https://sites.google.com/site/abigailsarticles/june-2025-articles
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Posted By Abigail Falk,
Wednesday, June 4, 2025
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Posted By Abigail Falk,
Thursday, April 24, 2025
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Posted By Abigail Falk,
Tuesday, March 25, 2025
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Posted By Abigail Falk,
Friday, December 20, 2024
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Posted By Administration,
Wednesday, November 20, 2024
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Clotted forearm graft with compression at the venous side of graft when examined with sono, patient had marked venous stenosis and hx of profuse bleeding from cannulation sites prior to clotting. What are your thoughts?
Attached Thumbnails:
Tags:
clotted forearm graft
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Posted By Martin Gorrochategui,
Friday, October 25, 2024
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Catheter exchange with sheath and filling defect at SVC
Thoughts?
Attached Files:
Tags:
Catheter Exchange
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Posted By Karn Gupta,
Thursday, September 19, 2024
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We have had several denials from Blue Cross Blue Shield (BCBS) for WaveLinQ pAVF creation code 36837. Their denial reason is "code is not covered as procedure is considered investigational. The members policy does not cover investigational services". We have appealed all of the denials with extensive comments/resources/literature (including it being an official CPT code, Medicare/Medicaid covering it, etc) but they have upheld their denial every time. Anyone else having similar issues? How else can we handle such denials?
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