Patients with kidney failure require either kidney transplants or dialysis to replace their lost kidney function. When your kidneys fail, your body is unable to clean and filter your blood. Toxins and electrolytes can accumulate in your blood stream which can become life threatening. Also your body may not remove excess fluid appropriately resulting in fluid accumulation in the lungs making it difficult to breath. If your kidney function falls below a certain level then dialysis is needed. There are different forms of dialysis including hemodialysis and peritoneal dialysis. We perform procedures that facilitate hemodialysis. Hemodialysis involves sessions where the blood of patients with kidney failure is continuously drawn from their body through needles or catheters and is then processed through dialysis machines. This blood processing replaces the lost kidney function. After processing, the “cleaned” blood is then returned to the patient’s body. We perform the following procedures to facilitate hemodialysis:
- Arterial - Venous (AV) fistula— This involves a surgical procedure that connects arm veins that are located close to the skin surface to nearby arteries. High pressure blood flow from the arteries induces these veins to enlarge and become thicker. Blood can then be easily and continuously drawn from these veins, processed through dialysis machines, and then returned to the body through another set of needles.
- AV graft—This a surgical procedure where a plastic tube is placed just under the skin of the arm or thigh and is connected to an artery and vein. When connected to the blood vessels a large volume of blood runs through the plastic tube similar to an AV fistula (described above). The blood can then be easily drawn from the body and processed through the dialysis machines and returned back to the body.
- Placement of a tunneled catheter in your neck—these catheters are usually temporary and meant to be a bridge for patients who need hemodialysis until either an AV graft or AV fistula can be placed.
Even though AV fistulas, AV grafts, and dialysis catheters ( all of these are sometimes referred to as dialysis access) are necessary to sustain life and patients with kidney failure, they are prone to complications. Those complications include infection, and clotting. If infection occurs this often requires removal of the access. If clotting occurs most times we can perform surgical procedures to remove the clot and restore function of the access. Clotting typically occurs in AV grafts and fistulas due to blockages that develop within these types of access. We typically monitor patients every three months in our office with ultrasound of the access and physical examination to detect and treat developing blockages before clotting occurs. Treatment of these blockages typically are short, simple procedures that we typically perform in our office and requires only light sedation.