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James Gilbert
Transplant and Vascular Access Surgeon. Medical Educationalist. Arm chair sports pundit but like to run do triathlons eat good food and enjoy good wine.
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James Gilbert retweeted
Merit Medical 24h
Merit's Think Dialysis Access course was in Berlin, Germany this week. Thanks to all who attended! See future courses here:
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James Gilbert retweeted
Jyoti Baharani May 15
Saying goodbye to the lengend of renal Vascular access that is Mr Teun Wilmink The hero of the humble AVF who has helped us achieve so much We will miss you terribly and wish u a happy retirement with no more broken bones 🦴😇 Good luck xxx from
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James Gilbert May 14
Replying to @RihanShahab
It is often overlooked that conservative care for ESRF is a form of treatment and maybe be better for some compared with traumas of lines / AVF creation and dialysis
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James Gilbert retweeted
Rihan Shahab May 13
Dr Susan Crail reports a disturbing statistic. 60.7% of patients regretted their decision to start with 51.9% starting it because it was their doctor’s wish. We need to get better at discussing treatment options for
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James Gilbert May 10
Move LC pts out of CKD clinics into specialist LC clinic with review in weekly access clinics to plan access. MDT to discuss best Access option and timing and dedicated theatre planner meeting to list patients. Early cannulation grafts for crash landers and always pushing LRD
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James Gilbert May 10
Appointing two LC Nephrologist’s and nurses been a game changer and a Low clearance MDT each month with access, PD and transplant team help us to list in timely fashion for preemptive access and / or tx. Having 4 theatre lists a week helps too
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James Gilbert May 10
Our LC programme has seen 65% new starters on avf or avg and highest uk rates preemptive tx.
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James Gilbert May 10
Proper low clearance programmes that patients enter between EGFR 15-20 enables broader approach that just saving the vein. It enables education of all RRT modalities including TX and results in right access right patient right time.
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James Gilbert May 8
The ring supports will progressively fractured and come away from the graft with repeated needling so over time increased likelihood of stenosis. I take same view with a ringed graft as I do a stent graft in the needling segment - don’t do it
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James Gilbert May 8
I don’t use either even when crossing joints and have had no issues.
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James Gilbert May 7
Replying to @robshahverdyan
What an incredible game and result. How have Barcelona been made to look so ordinary
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James Gilbert May 7
Very true and for all my super hero cases I use 6mm 50cm standard wall Flixene for the very reason you describe at the adaptor
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James Gilbert May 7
Over 200 Flixene in past 6 years and 82% secondary patency at 1 year and still above 65% at 5 years. Doesn’t feel like a reason to change
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James Gilbert May 7
Much more expensive
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James Gilbert May 7
I am not an acuseal fan. Does not incorporate well and can delaminate. The Flixene GW has only two layers at the ends so makes anastomoses really enjoyable as everts well
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James Gilbert May 7
You can cannulation acuseal much earlier as trilaminate quick stick PTFE. Have cannulated Flixene at 2 hours. Venaflo is standard two walled PTFE and therefore not quick stick
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James Gilbert May 7
If u can always tunnel with 6mm olive as this keeps the tunnel really snug around the graft and minimises tunnel haematoma risk
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James Gilbert May 7
IFU recommends 14 days. Have needled a few at 7days but generally now use Flixene in most cases
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James Gilbert May 4
Fun week of emergency access & developed Interventional Access Surgeon role with 7 declots, 3 venoplasty, 2 patch plasty, 2 quick stick in crash landers, a hero and a PD. Numerous patient consults to make right plan and deliver right access
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James Gilbert May 3
Fully agree. Fraiser sucker 5mm and fits through connector to do suction thrombectomy following small graftotomy on PTFE near connector point. These never clot from the outflow side and always something to do with PTFE side. Should ideally go completion o’gram.
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