Robert Shahverdyan, MD 🇦🇲🇩🇪
@robshahverdyan
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Vascular/Endovascular Surgeon, Head of Dialysis Access Center, endoAVF/sAVF. Loving father of 3, proud husband of PhD. My views represent evidence or experience
Hamburg, Germany
Joined September 2016
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Historic day for AV-Access: this 72 y/o female patient is (to my knowledge) the very first patient in the Milky Way, who has had the oldest (
#Scribner
-Shunt) and the newest (
#EllipsS
pAVF) in same arm in >30 years! Failing NTx, Ellipsys with 720ml/min procedural flow in 12 min.
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217
Once in a while there’s another (rare) type of
#AVFistula
we create: here’s an ulnar-basilic forearm
#AVF
with simultaneous transposition of the forearm basilic vein in a
#CKD
patient with no RCAVF option, high bifurcation of axillary artery and 3mm big ulnar artery
@wasse_m
15
11
115
It’s been a while since
@jimbog_76
won an
#Oscar
for his incredibly popular
#bottlecap
video, and (luckily) it’s the first one for me since then, so I thought I’d share. 98!!!!! y/o patient decided to bleed from her
#AVF
and guess what came for help? - The Bottle cap! 🤫😉
4
27
111
Interesting view 🤔: A > 1 year old AV-graft, occluded and abandoned ca. 3-4 weeks ago after a revision. Now, the occluded graft extrudes through the wound. Very noticeable cannulation sites after apparent kebabing of the graft for months 😳
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I’ve just placed a dialysis catheter!!! Totally successful, and safe 👊🏻👍😄 I’m sure…. I hope….. I think….
@wasse_m
@NMawlaMD
@SaadTheodore
@SocietyAccess
@ReidRavin
@LessneVIR
@DillavouEllen
23
1
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150
#Ellipsys
#pAVFs
#endoAVFs
in 4,5 years
#AsklepiosClinicBarmbek
#Hamburg
: median 13 min creation time; Nr. of Int/pt/years 0.44; 89% matured (79% at 4 weeks); total sec. patency 87%.
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9
75
When your resident steals your thunder and nails her VERY FIRST
#Ellipsys
#endoAVF
creation in 23 minutes in front of a live audience of 5 international participants of an Ellipsys workshop in
#VascularAccessCenter
#Hamburg
#Asklepios
#Barmbek
6
1
62
Getting ready for an arteriovenous Fistula creation 🤦🏻♂️🤷🏻♂️. Is there anything wrong with the picture? 😉
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Proud to have had performed 💯
#Ellipsys
#pAVF
creations
@Asklepios_HH
#Barmbek
#VascularAccessCenter
in
#Hamburg
in exactly 2 years with 100% technical success! Looking forward to another 💯 🤓
@AvenuMedical
@endoAVF
@bndriscoll
@EdChang18
@BeaRadz
@NMawlaMD
10
7
59
When a 7 y/o non-transposed brachio-basilic
#AVF
with 2,5 L/min looks like 👇 before and like 👇 after the revision (aneurysmorrhaphy, transposition, distalisation of 3 mm AV-anastomosis).
#VascularAccessCenter
#Hamburg
@Asklepios_HH
@asklepiosgruppe
7
7
59
Ever wondered how the deployment of
@WLGore
#Viabahn
looks like when ultrasound guided only? now you see it 😎
#POCUS
#alara
@SocietyAccess
@VASAMD
@Dialysis_Access
@KidneyAcademy
@wasse_m
@NMawlaMD
@LessneVIR
@CHICKVIR
@Vascupedia_com
@VascularNews
@SaadTheodore
@DaphniGray
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7
58
Ultrasound-guided balloon-angioplasty of juxtaanastomotic perforating vein with 5mm POBA and 6mm DCB in a 3 years cm old
#Ellipsys
#endoAVF
#pAVF
- in 15 minutes
#VascularAccessCenter
@LessneVIR
@CHICKVIR
@SocietyAccess
@VASAMD
@ASDINNews
@NMawlaMD
@wasse_m
@SaadTheodore
7
10
57
Okay, let’s do some ultrasound guided sharp recan of this occluded cubital cephalic vein in an AVF
@SocietyAccess
@NMawlaMD
@wasse_m
@LessneVIR
@CHICKVIR
@vandyniyyar
@VASAMD
@KidneyAcademy
@ASDINNews
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7
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Another lipectomy for forearm cephalic vein 6 weeks after radio-cephalic
#snuffbox
#AVF
creation
#VascularAccessCenter
#Hamburg
#Barmbek
#Asklepios
4
6
49
Marking all of the Hemodialysis Accesses for cannulations
@asklepiosklinik
#barmbek
#VascularAccessCenter
#Hamburg
#AVF
#AVG
#endoAVF
#pAVF
#VasQ
#Gracz
7
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47
Graft-venous anastomosis (GVA): the weakest spot of AVGs, leading to GVA-stenosis and AVG thrombosis. Take good care of it (avoid torsion, avoid stretching, make long VENOUS anastomosis), everyone will benefit from a meticulous surgery. New Forearm FLIXENE LOOP
#AVG
in failed VA
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8
45
Live from
#Hamburg
#Asklepios
#VascularAccessCenter
: First cases in Europe 🇪🇺 of AVF treatment using the novel FLEX vessel preparation (
@VMG_FLEX
) device: excellent visualization with ultrasound, easy handling and great outcomes! More at Hamburg Dialysis Access Symposium Sep 8-9.
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7
46
How it started (young physician moving to Cologne, Germany🇩🇪 from Armenia 🇦🇲 ) —> How it’s going (at 48th
@VEITHsymposium
with Vascular Access pioneers and experts W. Jennings, J. Lucas III, J. Ross,
@wasse_m
@SaadTheodore
). Proud and honored! Yes, Vascular Access is important!
1
5
46
We thrive to provide best possible treatment for our dialysis patients: innovations are huge part of it. Yesterday, 3 novel procedures were performed to provide dialysis access: 1)
#Ellipsys
#endoAVF
2) CVC using
#Surfacer
#InsideOut
and 3) RCAVF using
#VasQ
external support.
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8
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A 12-years old
#ESRD
kid 🧒:
#snuffbox
#AVF
@VascularAccessCenter
#HAMBURG
Now, tell me you’ve done that, or know somebody who has? 😎
@wasse_m
@KaremHarthMD
@ErbenYoung
@DillavouEllen
@CKeithOzaki
@dialysisaccess1
@nick_inston
@TzeWoeiTan
@hswapnil
@ahmedkayssi
@SaadTheodore
8
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43
The smartest and handsomest faculty members of the
@evameeting
….. who have shared a photo with me 😎
#EVA2023
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First case of endovascular thrombectomy of a thrombosed
#endoAVF
using
@ArgonMedical
#Cleaner
device in Hamburg Dialysis Access Center with minimal patient burden, performed by a vascular surgeon 😎😀
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5
41
Monday, Wednesday, Friday: Monday, Wednesday, Friday: Monday, Wednesday, Friday: Monday, Wednesday, Friday (EVERY, SINGLE, TIME).
#AVF
#ropeladdercannulation
#ESRD
#HD
@ASDINNews
@VascularNews
@SocietyAccess
@VASAMD
@Dialysis_Access
1
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40
Before. After. Aneurysmorrhaphy. AVF. Thursday.
6
2
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So
#medtweeter
. How often do u see a valve in the internal jugular vein (show me or it didn’t happen🤪)
@wasse_m
@jimbog_76
@NMawlaMD
@KaremHarthMD
@SaadTheodore
@ErbenYoung
@gertfrahmjensen
@nick_inston
@SocietyAccess
@VASBImedia
@VASAMD
@ASDINNews
@vandyniyyar
@dialysisaccess1
19
3
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When doing a thrombectomy of an arteriovenous graft (
#AVG
) make sure to pass through several times (and ideally under ultrasound guidance), because look at this old white crap coming out of it (72 hours old occlusion).
#VascularAccessCenter
#Hamburg
#AKB
#Asklepios
#Barmbek
6
4
41
And, here is the actual
@Medtronic
@AvenuMedical
#ellipsys
#endoAVF
#pAVF
creation in the same patient aiming distal! To make it clear: the Qa at the end is 900ml/min, since the patient had a 3 y/o now failed RCAVF, hence PRA is larger than usual, explaining direct „maturation“
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When you create a
#GRACZ
#AVF
4 years ago and the patient never comes to his FUs since the nephrologist says “it’s running good” yet never examines the AFV, and now the patient comes with THAT arm and THIS FLOW👇
#highflowavf
#aneurysm
#ArealCannulationsSuck
!
@wasse_m
@jimbog_76
8
7
37
12th successful
#Surfacer
Inside-Out procedure in a patient with occluded bilateral internal jugular, subclavian and brachiocephalic veins in Vascular (Dialysis) Access Center
#Hamburg
#Asklepios
Clinic - love when the wire penetration through the skin 💪💪💪😎
@BlugrssVascular
2
1
37
Sometimes I do crazy stuff, and sometimes I do CRAZY stuff: when the CKD patient has only upper and forearm basilic vein but only ulnar artery supply of the hand, you create a native forearm basilic transposition loop from the proximal radial artery
@wasse_m
#VascularAccessCenter
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Tell me there is a better way to close the first day of Masterclass at the 5th
#Hamburg
#Dialysis
#Access
#Symposium
(
#DAS
) 2023 (or any other day!) than a delicious faculty dinner with friends and a sunset AND fireworks over the Hamburg harbor! 💥 🛳️ ☀️
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Trying
#Covera
#Stentgraft
for this Typ IV cephalic arch subtotal stenosis in a (guess what?) - brachiocephalic
#AVF
.
@SocietyAccess
@BDandCo_PI
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3
35
#Hamburg
#Dialysis
#Access
#Symposium
(DAS) started today with hands-on Masterclass and live OR procedures (
#Ellipsys
and
#WavelinQ
#endoAVF
#pAVF
) at the
#Asklepios
#Barmbek
@asklepiosgruppe
💪💪💪
#VascularAccessCenter
5
7
35
Proud to announce that our paper on percutaneous AV-Fistulae was accepted to
@JVIRmedia
. Thanks to the reviewers and
@ZHaskal
for quick process and acceptance! Follow
@JVIRmedia
for more updates on the manuscript when available online.
1
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35
Are you ready for the next 5th Hamburg Dialysis Access Symposium? SAVE THE DATE: Sep 8-9th in beautiful
#Hamburg
#Germany
. International faculty from all over the world sharing their experience at
#AsklepiosClinicBarmbek
at only international dialysis access meeting in Germany!
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9
33
Honored to be a part of this extraordinary panel. Everyone interested in
#endoAVF
#pAVF
should attend. Register under
#VEITHSymposium
@SocietyAccess
@VASBImedia
@VASAMD
@Vascupedia_com
@Dialysis_Access
@dvacoalition
@KidneyAcademy
@VEITHsymposium
3
12
34
When a
#Supera
stent
@AbbottNews
is deployed under Ultrasound guidance
#POCUS
#AVF
#sharprecan
#ESRD
#HD
#VascularAccessCenter
#Hamburg
@VASAMD
@SocietyAccess
@ASDINNews
@wasse_m
@LessneVIR
@NMawlaMD
@SIRspecialists
4
4
33
Congratulations and huge thanks to the whole team of the
@evameeting
for excellent organization and support of one of the best Dialysis Access related meetings!
#EVA2023
2
3
33
Is this 45cm long radial artery to brachial vein
#AVG
enough to avoid Areal cannulations? 🫤🤫🤔 We‘ll see, we‘ll see
#ESRD
#FLIXENE
#HD
#VascularAccessCenter
#Hamburg
@wasse_m
@jimbog_76
8
4
30
Incredibly educational and entertaining debate on
#endoAVF
versus
#sAVF
lead by two greats:
@NMawlaMD
(Nephrology) versus John Ross (Surgeon)
@VEITHsymposium
2
1
30
1
2
31
Teaching, learning, and having fun with the best in the Vascular Access field
@wasse_m
@jimbog_76
and
@HohmannStephen
during the
#EVC2023
1
4
31
Great talk from
@aishaikh
at
#VEITHSymposium
- So, what Dialysis Access should we place in chronic hypotensive patients?
@VEITHsymposium
3
7
31
Remember this guy? The one with the very first ever ipsilateral Ellipsys after WavelinQ
#endoAVFs
in the Milky Way - almost 5 years later! 👍🏻👊🏻😎 (with patient’s permission).
0
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The preliminary program to this year's 5th Masterclass and Dialysis Access Symposium in Hamburg is available & registrations are open now!
@asklepiosgruppe
@SocietyAccess
@VASBImedia
@VASAMD
@ASDINNews
@VascularNews
@Vascupedia_com
@ESVSmembership
@EVST_ESVS
@BDandCo
@Medtronic
5
15
30
And here it is: submitted and accepted - available
@JVA
soon. Thanks
@aishaikh
and
@MGallieni
for the advice
4
4
31
Getting ready for the next
@CXSymposium
- looking forward to a spectacular whole Vascular Access day with friends and colleagues
#CX2023
P.S. and now some sightseeing 🤫😉
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@ReidRavin
@SharifEllozy
@martknowles
My nephrologists are the best: this is daily routine at our dialysis unit - here an example of U/S guided cannulation with pocket size
@generalelectric
device of an
#endoAVF
after 6 days post creation.
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Hard to believe that anyone would not only tolerate being married to me for 16 years, but also stand by me, support me, give birth to 3 beautiful children and make it to a PhD in biology!
#wifewhorocks
#bestwife
#MrsPhD
#anniversary
@ Clouds
#Hamburg
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You know you’re doing something good when the great
@edgarvlermamd
presents TWO of your publications during the “Jedi Wisdom Session” at
#ASDIN2022
meeting. Thanks to
@ASDINNews
for the kind invitation to an excellent meeting!!!
@wasse_m
@JVIRmedia
2
4
27
The very first and successful Endovascular AV-Fistula in Hamburg!!!
At our Vascular Access Center, Asklepios Klinik Barmbek.
#creatingfistulas
#shuntzentrum
#asklepiosklinikbarmbek
#tvamedical
#everlinQ
0
7
28
Even at this difficult times I am happy to offer our dialysis patients the best possible treatment. Today, we have implanted our 💯th external support device
#VasQ
during AVF creation with 74 forearm procedures having 89% secondary patency!
#vascularaccesscenter
#hamburg
#barmbek
0
5
27
Ultrasound guided only transradial (very distal transradial) balloon angioplasty (BAM) of a snuffbox
#AVF
due to distal forearm stenosis of the cephalic vein.
#BAM
! Qa post-PTA 880ml/min
#VascularAccessCenter
#Hamburg
#CKD
3
1
26
🤭😱
An Unusual Case of a Displaced Hemodialysis Catheter Guidewire Spontaneously Coming Out of Skull
#VascularAccessPearls
@ASDINNews
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135
425
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4
26
Type III cephalic arch stenosis in a 2 y/o BCAVF w 600ml/min flow and high venous pressures. Typical problem. PTA w 8mm Mustang Balloon
@BSCCardioAPAC
under 20 ATM 🔜 👇🏻 💥. Now what?
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2
26
Found this in my P.O. Box today 😱 & had to brag about it, since that’s like the only award I‘ve ever won, so this is equally shared with thanks to group of extraordinary people who worked with me on that publication-
@TerryLitchfield
G. Beathard, W. Jennings, N. Mushtaq
@prn19
4
0
27
Who else finds it extremely annoying, when EVERY SINGLE PATIENT with an occluded AVF/AVG presents themselves with at least 3 sticks in that same occluded VA instead of using medieval methods such as feel the thrill or just put that strange thing called stethoscope on your ears.
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2
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Apparently operating on a pomegranate is the new subspeciality of a vascular Access surgeon 🙈🤷🏼♂️
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