Dialysis is a critical form of treatment for people with end-stage renal disease. Specifically, hemodialysis is a process in which your blood is transported through tubes to a dialysis machine, where it’s filtered and then returned to your body. 

In order for this process to occur, an access point — also known as a vascular or dialysis access — must be surgically created. Here’s a brief look into the common types and how they’re maintained to ensure dialysis treatments can continue.

What Are the Types of Dialysis Access?

All access placement is performed through minor surgery. Patients who receive hemodialysis will use one of the following access types:

  • Fistula: This type of access is created by surgically joining an artery directly to a vein in your arm. The vein near the connection to the artery will slowly enlarge, and after about a month, it will become accessible via needles for dialysis. Until then, patients typically require a catheter to receive dialysis. Fistulas require more work to create but can last up to a decade.
  • Graft: This access is made with a soft plastic tube that joins an artery and vein in your arm or groin. After the graft has healed, it can be accessed by two needles during dialysis. In the meantime, most patients will require a catheter. Because grafts are less likely to become infected, they’re often preferred over catheters.
  • Catheter: A catheter access involves two plastic tubes that are joined wherever they’re placed in the body, such as your neck or groin. One of the tubes transports blood out of the body while the other returns filtered blood. While catheters are often used as an interim solution when fistulas or grafts are healing, they’re typically not recommended as a long-term solution because they have a higher risk of infection.

Some patients may instead receive peritoneal dialysis, which uses the abdominal lining and a sterile solution to cleanse the blood. This approach allows for either continuous ambulatory peritoneal dialysis (CAPD), which is done by hand, or automated peritoneal dialysis, which is done by a machine. In either case, peritoneal dialysis requires catheter placement in the abdomen.

Your nephrologist (kidney specialist) will work closely with one of our vascular doctors to determine the best approach for your dialysis access.

How Can You Keep Dialysis Access Points Viable?

Access management is important to ensuring you’re able to receive dialysis treatments successfully. Here at Vascular Surgical Associates, we use ultrasound imaging to routinely monitor dialysis access. By catching issues early on, we can intervene quickly and prolong the life of the access. Some dialysis access management procedures include:

  • Fistulogram: If a graft or fistula isn’t supplying the dialysis machine with enough blood, vascular surgeons may perform a fistulogram. This process works by injecting an IV contrast into the graft to determine areas where it may have narrowed or become blocked.
  • Balloon Angioplasty: This procedure may be performed to open the blood vessel. Additionally, a metal stent can be placed to keep the blood vessel open.
  • Declot Procedure: Should a clot form in the graft or fistula, you may receive one of two different declot treatments. Catheter-directed thrombolysis involves the removal of clots through the injection of medicine, while mechanical thrombectomy physically removes or breaks apart the clot.

If you’re seeking a team of vascular surgeons to assist you or a loved one in dialysis access management, turn to Vascular Surgical Associates. In addition to monitoring for and addressing issues with dialysis access, we can also perform catheter placement for immediate dialysis. Schedule an appointment with us online, or call 770-423-0595.