Vascular (Dialysis) Access Surgery
Hemodialysis is a treatment for kidney failure that uses a machine, outside the body, to remove waste products for the blood. In order for the treatment to work, large volumes of blood must be rapidly removed from the patient’s body, passed through filters in the machine, and returned to the body. The veins we have are too small, too fragile, and don’t carry enough blood to be used in their natural state for hemodialysis. Therefore, every patient who begins hemodialysis must undergo an operation which allows them to be connected to the dialysis machine. These procedures are called vascular access procedures.
There are two vascular access procedures for long-term use, arteriovenous fistulas (called fistulas) and arteriovenous grafts (called grafts). A third type of vascular access, a hemodialysis catheter, is only for short-term use.
A fistula is a direct surgical connection between an artery (high flow/high pressure blood) and a vein (low flow/low pressure).
- After this connection is created, over time, the vein will dilate and its wall will thicken.
- Once this process is completed (the fistula has matured), dialysis technicians can stick needles into the fistula to connect the patient to the hemodialysis machine.
- The time required for a fistula to mature is generally 6 – 8 weeks.
- The benefits of a fistula over a graft or a catheter are: it generally lasts longer than other vascular access types and it is resistant to infection.
A graft is a plastic tube that is implanted into a patients arm or thigh.
- One end of the tube is connected to the side of an artery. The other end of the tube is connected to the side of a vein. After those connections are made, blood flows continuously through the graft from the artery to the vein.
- Two to three weeks after the graft is implanted (remember- the graft lies beneath the skin), the graft is ready for use.
- The dialysis technician connects the patient to the machine by sticking needles into the graft.
- Although the graft has a higher infection rate and clots more often than fistulas, many patients have grafts that last for years.
- Vascular access surgery is usually an outpatient procedure. In many cases, the patient can choose their preferred anesthesia. These procedures can be done using local anesthesia with sedation, with a regional limb block or spinal, or with general anesthesia. The anesthesiologist will talk to you about the anesthesia technique that best suits your situation.
How do I find a physician to treat my condition?
For further questions or to make an appointment please contact the Vascular Health Alliance at 864-454-8272.