Dialysis Access

If your kidneys fail, and until you receive a kidney transplant, you will need dialysis treatment. Your blood must be filtered and cleansed to ensure that electrolyte levels — ex., potassium and phosphorous — do not rise to dangerous levels. In order to treat you, dialysis access must be established at an appropriate location.  There are four ways this may occur:

1. Central Venous Catheter (CVC): a catheter can be placed in one of several locations, but this is not an ideal option in most circumstances. This is due to the higher risk for infection.
2. Arteriovenous Fistula (AVF): this involves sewing a vein into a nearby artery, typically in the arm. The vein will then mature and become dilated from arterial flow. This may take a minimum of six weeks, but usually longer. This option is considered ideal due to the low risk of infection.
3. Arteriovenous Graft (AVG): this involves sewing a bovine or prosthetic graft between an artery and a vein, typically in your arm. This option is best if your vessels are not of adequate size to use in an AV fistula. AV grafts can be used for dialysis relatively quickly, but the risk of infection is marginally greater.
4. Peritoneal Dialysis: A small tube called a cannula is placed in the abdomen to make it possible for the abdominal lining (peritoneum) to filter the blood. Fluids must be exchanged several times a day. This option is convenient because dialysis treatment can occur in the home. However, this option may introduce complications in the form of increased infection risk and potential clogging of the tube.

Regardless of what type of dialysis access is used, each of the methods listed above will require periodic maintenance to keep them functioning properly.

AV Access failure to mature: this refers to a failure of the outflow vein to mature to proper size. Typically, an arm vein used to create a dialysis access needs to “mature” to at least 0.5cm.  If the vein fails to mature in size, it may require either an open surgical revision or a minimally invasive endovascular procedure to repair.

AV Access Stenosis: stenosis is a narrowing affecting either the artery or the vein which decreases the performance of the fistula. Typically, this is treated with a balloon angioplasty which is the most common procedure performed on a dialysis access. The good news is that balloon angioplasty procedures typically take less than 30 minutes and can be performed in an office-based setting like Allegheny Vein & Vascular.

AV Access Thrombosis: sometimes, for any number of reasons, the fistula or graft will clot off and become unusable unless taken care of quickly. This is commonly treated with endovascular techniques to remove the clot via suction and/or use catheter-directed thrombolytics to dissolve the clot.

AV Access Steal Syndrome: when the artery is surgically attached to the vein to create the dialysis access fistula, too much of the blood flow can be diverted into the fistula which reduces blood flow to the hand. Although uncommon, it can be a serious condition which may require either an open surgical revision or ligation of the fistula.