Vascular Dialysis Access
Three Types Of Vascular Access:
- Arteriovenous (AV) fistula
- Arteriovenous (AV) graft
- Central venous catheter or internal port devices
Each access is created surgically. There are a limited number of places on the body where an access can be placed—the arms, legs, neck or chest.
The fistula and graft are considered to be permanent accesses because they are placed under the skin with a plan to use them for many years. When patients find out they are in the advanced stages of chronic kidney disease and will be starting dialysis in the future, their nephrologist will advise them to get a fistula or graft. Having the access in place well before beginning dialysis will give this lifeline time to “mature,” so it can be ready to use.
When patients suddenly discover they have kidney failure, a catheter may be placed to allow for immediate dialysis treatment. The catheter will be used until a fistula or graft has time to mature. A catheter can also be used on a permanent basis, if the patient is unable to have a fistula or graft—but a catheter is always a last resort.
An AV fistula is created by directly connecting a person’s artery and vein—usually in the arm. This procedure may be performed as an outpatient operation using a local anesthetic. As blood flows to the vein from the newly connected artery, the vein grows bigger and stronger. The patient is taught to do exercises—such as squeezing a rubber ball—to help the fistula strengthen and mature to get it ready for use. This takes anywhere from six weeks to four months or more. Once the fistula has matured, it can provide good blood flow for many years of hemodialysis.
The AV graft is similar to a fistula, in that it is also an under the skin connection of an artery and vein, except that with a graft, a man-made tubing connects the artery and vein. The soft, plastic-like tube is about one-half inch in diameter and is made from a type of Teflon or Gore-Tex material. Transplanted animal or human vessels may also be used as grafts to connect an artery and vein. Grafts are usually placed in the arm, but can also be placed in the thigh.
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Grafts do not require as much time to mature as fistulas, because the graft does not need time to enlarge before using. In most cases a graft can be used about two to six weeks after placement. Because grafts are created from materials outside of the body, they tend to have more problems than fistulas due to clotting and infections. Grafts may not last as long as a fistula and could need to be repaired or replaced each year
When you are referred to our office, we will perform an extensive history and physical exam. We will also frequently order a venous ultrasound scan to search for the most suitable veins available for AV fistula formation. Many times, we will give borderline veins a try because the benefit of fistula over the other options is so significant.
Frequently, fistulas and grafts need ultrasound surveillance. We at West Coast Vascular will follow your fistula and graft for many years after we create them in order to pick up sub-clinical blockages that may affect the performance of your AV access. Many times we can treat these problems before they affect the function of your fistula. This allows minimal interruption of your dialysis and minimize the chances of needing a catheter for dialysis.
When your fistula or graft does fail and shut off. We have a access to dedicated outpatient facility that allows us to get you in within 24 hours, and open up your AV access using minimally invasive techniques. We work closely with your nephrologist and dialysis center to limit the interruption to your dialysis schedule. The timely treatment of the problem allows you to carry on your life with little disruption.