Dialysis Access Procedures

Our physicians specialize in the following procedures:

  • Arteriovenous fistula and graft creation, thrombectomy, fistulagrams, MILLER Banding
  • Angioplasty and stenting, venograms, arteriograms, fistula salvage
  • Peritoneal dialysis catheter placement and repositioning

Dialysis Access Management Services

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Arteriovenous Fistula and Graft Creation

Our physicians offer both arteriovenous fistula and graft creation. An arteriovenous fistula (AVF) is created by surgically connecting a vein to an artery. Common locations are the wrist or above the elbow. An AVF is the preferred type of access. An arteriovenous graft (AVG) is surgically created using synthetic material such as GORE-TEX to connect an artery and vein. The non-dominant arm is the most common location.

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Thrombectomy & Thrombolysis

For clotted accesses, we offer thrombectomy (or embolectomy), to remove thrombi (blood clots) from the access. Mechanical thrombectomy devices which create a vacuum effect, can remove clots from both AV fistulas and grafts, by pulling out the clots.

Another alternative to remove clots is thrombolysis, which utilizes pharmacological agents to break down or break up these blood clots.

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Fistulagrams

In order to assess where a problem is located with an access, our doctors will perform a fistulagram or an x-ray to look at the blood flow and check for blood clots or other blockages in your fistula.

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The MILLER Procedure for Steal Syndrome

Steal syndrome is a clinical condition caused by arterial insufficiency distal to the dialysis access (area furthest away from the center of the body). Blood is diverted into the fistula or graft and away from the hand. To correct the balance of blood flow, we offer a banding technique, the Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) procedure to accurately manipulate the access to the proper size and allow for even blood flow. This procedure uses an angioplasty balloon as a sizing dowel, allowing our physicians to band accesses to their desired diameter to treat steal syndrome and high-flow accesses.

Venous Angioplasty, Stents, Venograms, Arteriograms and Fistula Salvage

Many poorly functioning accesses suffer from stenosis, which is a blockage or narrowing in the access. To open a stenosis, we may intervene with angioplasty and/or stent placement to improve blood flow. Angioplasty and vascular stenting are minimally invasive procedures performed to improve blood flow in the body’s arteries and veins. A venogram or arteriogram is the technology that allows our doctors to determine where the blockage in your vein or artery is occurring.
venogram

Venogram

This is an x-ray test where the doctors inject x-ray contrast material (dye) into a vein to show how blood flows through your veins. This is a minimally invasive medical test that helps us to diagnose and treat various medical conditions related to veins.

Arteriogram

This is an x-ray test where the doctors inject x-ray contrast material (dye) into an artery to show how blood flows through your arteries. This is a minimally invasive medical test that helps us to diagnose and treat various medical conditions related to arteries.

angioplasty

Angioplasty

In the angioplasty procedure, imaging techniques are used to guide a balloon-tipped catheter, a long, thin plastic tube, into an artery or vein and advance it to where the vessel is narrow or blocked. The balloon is inflated to open the vessel, then deflated and removed.

A balloon catheter is a long, thin plastic tube with a tiny balloon at its tip. A stent is a small, wire mesh tube. Balloons and stents come in varying sizes to match the size of the narrowed vein or artery.

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Stenting

In vascular stenting, which may be performed with angioplasty, a small wire mesh tube, called a stent, is permanently placed in the newly opened artery or vein to help it remain open. There are two types of stents: bare stents (wire mesh) and covered stents (also commonly called stent grafts).

Stents are specially designed mesh, metal tubes that are inserted into the body in a collapsed state on a catheter and then expanded inside the vessel to prop the walls open. In some cases the stent may have a synthetic fabric covering.

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Fistula Salvage

For arteriovenous (AV) fistulas that have not “matured” for optimal dialysis treatment, we can provide a series of angioplasty and/or stenting treatments to expand the access. This series of access interventions, performed over the course of a few weeks, is known as fistula salvage.

Conditions Treated with Angioplasty and Stenting

Angioplasty and angioplasty with vascular stenting are commonly used to treat conditions that involve a narrowing or blockage of arteries or veins throughout the body, including:

Renal Vascular Hypertension

Renal Vascular Hypertension is high blood pressure caused by a narrowing of the kidney arteries. Angioplasty with stenting is a commonly used method to open one or both of the arteries that supply blood to the kidneys. Treating renal arterial narrowing is also performed in some patients to protect or improve the renal function.

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Narrowing in Dialysis Fistula or Grafts

It is very common to see narrowing involving the dialysis fistula or graft. When there is decreased flow in the graft or fistula that is not adequate for dialysis, angioplasty is generally the first line of treatment. Stenting or stent-grafting may also be needed in some cases.

In these procedures, x-ray imaging equipment, a balloon catheter, sheath, stent, and guide wire are used.

The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. A guide wire is a thin wire used to guide the placement of the diagnostic catheter, angioplasty balloon catheter, and the vascular stent. A sheath is a vascular tube placed into the access artery, such as the femoral artery in the groin, which allows catheter exchanges easily during these complex procedures.

This procedure is often done on an outpatient basis.

Central Line Placements

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Central Venous Catheter Placement

We offer dialysis catheter placement. The catheter is a flexible hollow tube which is tunneled under the skin from the point of insertion in the vein to an exit site on the chest wall. However, catheters are typically only used for the shortest length of time possible because they are prone to clotting, infection, and kinking. A catheter may be placed while a fistula or graft is waiting to mature. Once your AV fistula or graft is functioning properly, we will safely remove your dialysis catheter.

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Peritoneal Dialysis Catheter Placement and Repositioning

Peritoneal dialysis is a process that uses the patient’s peritoneum in the abdomen as a membrane across which fluids and dissolved substances are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and is flushed out through regular exchanges. We can place the permanent tube, called a peritoneal dialysis catheter, if it is determined that this is the best method of dialysis for you.

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