Dialysis Access Surgery
Dialysis access surgery is a term for procedures that allow patients with renal failure a way to undergo hemodialysis. Hemodialysis is a treatment that “cleans out” the blood similar to what the kidneys normally do.
Because of the long-term need and frequency for hemodialysis, we require durable access to a patient’s bloodstream.
The solution is to create a direct connection between a high-flow artery and a vein that can be accessed with IV needles. We usually create this connection in the arm using either a fistula or a graft.
A fistula is when we sew an artery directly to a vein, and a “graft” is when we sew the artery to a synthetic tube and place the tube under the skin, and then sew the other end to a vein.
There are many reasons for choosing one type of procedure over the other that are unique to each individual patient. If you require dialysis access surgery, we will conduct some tests to see which procedure is best for you.
Tests and Diagnosis:
Ultrasound is usually the first test to evaluate whether a patient can receive a fistula or graft. Both arms are mapped to show where the veins lie and whether they are healthy, branched, or open.
We may use venography to image the arm veins and the more central veins under the ribs and collarbone. This test may be necessary if abnormal flow through the more central veins seems to be present, which can impact whether or not a fistula or graft will work properly.
Dialysis Access Surgery Options
A primary arteriovenous fistula (AVF), connects your vein to your artery is the first choice for this procedure. However, if you do not have adequate veins that can be used for surgery, a graft AVF is necessary. A graft AVF is a synthetic piece of tubing that we use in place of your own vein.
Placement of an arteriovenous fistula or graft typically doesn’t require an overnight stay in a hospital. We can do it under general anesthesia, local anesthesia at the incision site, or anesthesia that numbs the entire arm.
Afterwards there will be a new vibration sensation, or ”thrill”, over the graft and possibly some swelling that should subside. You will then have frequent follow-up checks to make sure the fistula or graft is working properly.