For patients experiencing kidney failure, the body loses its function to properly filter and remove toxins from the bloodstream. In such event, a patient will either need to have a kidney transplant on be started on dialysis. Dialysis is a treatment method designed to remove toxins and excess solutes from the blood, and is managed by a kidney specialist (nephrologist). If dialysis is prescribed by the nephrologist, a vascular surgeon will create a means of accessing the vein or artery to establish an entrance to continually filter blood when the patient receives dialysis treatment. The vascular surgeon works closely with the nephrologist and dialysis center to determine the best option for establishing dialysis access through one of the four methods listed below.
Our team strictly adheres to the DOQI (Disease Outcomes Quality Initiative) criteria and uses a “fistula first” strategy. All patients undergo preoperative vein mapping or venography. Dialysis access is tailored to the individual patient to provide each patient with the most durable hemodialysis or peritoneal dialysis access.
- Tunneled catheter: A tunneled dialysis catheter is often used for temporary dialysis access. The catheter is placed in a vein in the neck and is routed under the skin, where the catheter exits the skin near the chest or shoulder.
- AV Fistula: An AV (arteriovenous) Fistula is often considered the best option for dialysis access since rate of infection is low, it is longer lasting, and is less likely to clot. An AV Fistula is created when the surgeon takes a piece of a pre-existing vein from the patient’s arm or leg and sews it to a nearby artery.
- AV Graft: Similar to a fistula, an AV Graft is often placed in the arm, the main difference being that an AV graft is a synthetic tube that connects the artery and vein. This tube connection operates as a vein cand carries blood through the access. AV grafts are safe and effective if a fistula is not a good option, however grafts do have a higher rate of infection since they are not formed from natural tissue, and develop an increased risk of clots.
- Peritoneal Dialysis (PD): for eligible patients, a small tube is placed in the abdomen to allow the use of the lining of the abdomen to filter the blood. A connection to a specific solution through a catheter filters through the blood stream several times a day to exchange and discard the level of toxins in the bloodstream.