Hemodialysis Access

Kidneys fail for a variety of reasons, including long-standing hypertension, diabetes, infection, drug reaction, or various congenital abnormalities. There are two life-saving options for failing kidneys: dialysis or a kidney transplant. Hemodialysis involves removing blood from the body and circulating it through a machine that functions as an artificial kidney, removing impurities and extra fluid, balancing electrolytes, and returning the filtered blood to the body.

Creating an Access

To achieve good dialysis, you must have a high-flow conduit (an “access”) through which blood can be easily removed for cleansing and then returned to the body. This is where a vascular surgeon comes in.

There are three types of access, including:

The catheter is usually temporary because catheters have a high rate of complications, including infection and damage to the veins. The best long-term dialysis access is an AVF, provided the patient has a suitable arm vein. This can be determined by doing an ultrasound of the veins, (venous mapping) to determine their size and to be sure that they are open and not damaged from prior intravenous lines or blood draws.

An AVF or AVG is completely implanted underneath the skin. Nothing is visible outside the body between dialysis sessions. During dialysis, two needles are placed into the access and are then connected to the dialysis machine. One needle draws blood out of the body, and the other returns it after it has circulated through the dialysis machine.

Maintaining the Lifeline

Hemodialysis access is not a perfect science. It is not uncommon to require more than one procedure to achieve a stable access and maintain it over time. That access is a patient’s lifeline, and our vascular surgeons, dialysis nurses and technicians, and nephrologists work as a team to preserve it.

You will be taught how to check your access, something that must be done daily. Our team will also monitor it closely by examining it and taking flow readings off the dialysis machine as well as by performing a quarterly ultrasound. The ultrasound will help to detect areas of narrowing (stenosis) or bulges (pseudoaneurysms), which may threaten the longevity of your access.

Finding and fixing these problems early helps us achieve remarkable long-term outcomes. Our team consistently exceeds the goals set by the Centers for Medicare and Medicaid Services (CMS) for the Fistula First Breakthrough Initiative.

Our remarkable success rate with dialysis access is due to a combination of:

  • Careful mapping prior to the procedure
  • Routine, ongoing ultrasound surveillance after the procedure
  • Close communication between nephrologists and the dialysis center
  • Our vascular surgical teams’ mastery of targeted endovascular techniques that allow us to salvage failing accesses