DIALYSIS ACCESS MANAGEMENT
Vein mapping is an x-ray test used to determine the diameter, length, and suitability of the superficial veins for placement of a dialysis access. It is performed by injecting contrast into the veins or by use of ultrasound.
Arteriovenous Fistula & Graft Creation
Our surgeons 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-TEXTM to connect an artery and vein. The non-dominant arm is the most common location.
Angioplasty, Stenting, & 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. In angioplasty, a small balloon, mounted on a catheter, is inflated within the blood vessel, expanding the narrowed access. If necessary, we may also insert a metal stent to maintain even blood flow throughout the access. 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.
Thrombectomy & Thrombolysis
For clotted accesses, we offer thrombectomy (or embolectomy), to remove thrombi (blood clots) from the access. Mechanical thrombectomy devices can remove clots from both AV fistulas and grafts, creating a vacuum effect to pull out the clots. Another alternative to remove clots is thrombolysis, which utilizes pharmacological methods to break down or break up these blood clots.
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 up to three weeks 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.
To learn more about dialysis access management, visit Azura Vascular Care.