VASCULAR SOLUTIONS - Vascular and Endovascular Surgeons Treating Peripheral Vascular Disease in Cleveland, Ohio

Vascular Solutions

Types of Hemodialysis Access

Catheter

Catheter access requires the placement of a large bore double lumen catheter into a large vein in the neck or shoulder region which places the type of the catheter close to the heart. These catheters may be placed directly through the skin or tunneled under the skin so as to retard or prevent infections. Regardless of the type of catheter, they are prone to infection and thrombosis. They can also cause scarring of the vein. Such scarring can reduce sites for future access and presents a very difficult problem at times. Also, showering and bathing must be done carefully to avoid contaminating or dislodging the catheter.

AV Fistula

An AV fistula is a direct connection between an artery and vein. The most common sites for AV fistula are the forearm and upper arm. They are the most effective and preferred form of access surgery. Vascular Solutions prides itself on the number of fistulas it is able to create in most patients. Prior to use of the fistula, it must be allowed to mature which can take up to 6-8 weeks. It is best to perform these procedures well before a patient needs dialysis, but if the need arises prematurely before the fistula is ready, a temporary catheter may be placed. Again these are considered the optimal type of access but not all patients will have suitable veins for this procedure.

Av Graft

An AV graft is comprised of a bridging, synthetic tube or graft that spans the distance between an artery and vein. The artificial tube is punctured with the needles and provides a high flow conduit with rapid exchange of blood during dialysis. The grafts are typically made out of polytetrafluroethylene (Gore Tex - which is often used in making waterproof clothes and jackets). They are placed under the skin with no aspect of it exposed. Because of needles that penetrate through the skin into the plastic tube, infections can occur. Clotting also can occur with these grafts due to internal scarring of the vein. Your dialysis nurse is a tremendous help in diagnosing problems with the graft and we work with the dialysis team very carefully to monitor all of the access operations Vascular Solutions performs.

Summary

Dialysis access is a necessary lifeline for the renal failure patient. Access problems can be vexing and frustrating for the nephrologist, vascular surgeon, and most importantly you, the patient. We want to assure you that Vascular Solutions are in this together as a team and are at your service to provide any necessary help to maintain problem free dialysis.

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