Hemodialysis Access

Hemodialysis Access

Kidneys fail for various reasons, including high blood pressure, diabetes, kidney infection, drug reaction, or even just how someone is born. Kidney function is essential for life, and currently there are only two life-saving options to replace failing kidneys: dialysis or a kidney transplant. Hemodialysis is one of two ways to do dialysis that involves removing blood from the body, running it through a machine that cleans the blood, and returning the filtered blood to the body.

To do hemodialysis, you must have a way (“access”) through which blood can be quickly and easily removed from and then returned to the body. This is where a vascular surgeon comes in. Hemodialysis access is something that varies from person to person and changes over time. To make and maintain good access, it is common to need more than one procedure during the time that the access is used, which can range from several months to many years. The dialysis access is a patient’s lifeline, and our vascular surgeons, dialysis nurses, technicians, and nephrologists work as a team to preserve it.

There are three types of access that can be used for hemodialysis:

Post-Operative Expectations

After surgery, never let anyone draw blood, start an IV, or take blood pressures on the arm with the AVF or AVG. Any of these can potentially damage the access and lead to clotting and failure of the AVF/AVG. To some degree, every AVF/AVG diverts blood that would typically go to the hand (“access steal”). This may cause numbness or cramping in the hand during dialysis or when the blood pressure is low, but it is usually does not cause problems off dialysis. Occasionally, the symptoms can be more severe; persistent pain, numbness, or weakness in the hand and any finger wounds must be reported immediately to your surgeon. If these steal symptoms are bad enough, another operation may be needed to improve the blood flow to the hand while making every effort to keep the AVF/AVG in place.

Maintaining the Lifeline

You will be taught how to check your access, which should be done daily. Other ways of keeping track of the access are by examining it in person, taking measurements from the dialysis machine of the access and how well the machine is able to clean the blood, and having a regular ultrasound of the AVF/AVG. An ultrasound can detect areas of narrowing (stenosis) or bulging (aneurysm or pseudoaneurysm), which will affect how well the access works and increase the chances of access failure and clotting.

Ultrasounds are recommended every 3-6 months depending on the type of access and any previous problems. If an issue is found, a minimally invasive maintenance procedure (fistulogram) can often be done using balloons and stents to keep the access open and flowing properly for as long as possible. Identifying and fixing problems early is key to achieving superb long-term outcomes.

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

  • Careful mapping and planning before surgery
  • Scheduled, ongoing ultrasound surveillance
  • Easy, close communication between surgeons, nephrologists and the dialysis center
  • Our vascular surgical team’s mastery of open and endovascular techniques allow targeted treatments to save a failing access