Dialysis Access Management

For the more than 475,000 patients requiring life-saving dialysis treatment, access is everything. If a graft or fistula is blocked or even somewhat obstructed, it could lessen the amount of dialysis received. That could seriously jeopardize a patient’s health, and even shorten their life span.

American Endovascular affiliated centers enable qualified medical professionals to provide a range of minimally invasive-image guided dialysis access management procedures. These procedures are to manage and prolong the life of dialysis access grafts and fistulas, so patients can get the dialysis treatment they need without anything getting in the way.

How does dialysis work?

End-Stage Renal Disease (ESRD) occurs when the kidneys no longer function as they’re supposed to. The job of the kidneys is to remove excess waste products and fluids from the body, as urine. When kidney failure occurs, these substances have nowhere to go. They build up in the bloodstream which can cause a range of life-threatening conditions, to nearly every part of the body. Dialysis treatment is designed to replicate the function of the kidneys, cleaning impurities, and excess fluid from the blood.

Dialysis begins with the creation of an access—a point where the dialysis system can connect to the patient’s bloodstream. Three common methods are:

  • AV fistula—a surgically created connection between the artery and the vein. This is the preferred method, as it is 100% original tissue, which means a fistula can resist clotting and infection.
  • AV graft—a small tube—an indirect connection between an artery and a vein via a plastic tube or possibly a donated cadaver artery.
  • Hemodialysis Catheter Placement– An endovascular specialist utilizes ultrasound fluoroscopic images to precisely place a catheter through the major vein (preferably jugular) to allow removal of blood to be cleared with the hemodialysis machine then replaced back into the venous system with the blood that has been cleansed. This catheter should be considered as a temporary catheter to final access creation or renal transplant.

How does dialysis access management work?

When AV fistulas or grafts malfunction—usually as a result of narrowing or blockage due to frequent use—American Endovascular affiliated physicians can help remedy the problems using an array of minimally invasive procedures designed to restoring blood flow and prolong the longevity of the access so dialysis can continue.

Why choose American Endovascular Affiliated Centers for Dialysis Access Management


Physicians can offer multiple treatment options to prolong the life of fistulas and grafts, diminishing the need to put patients through multiple access surgeries at American Endovascular affiliated centers. The American Endovascular team of affiliated physicians specializes in complex endovascular care and are leading experts in dialysis access management. They know what it takes to help medical professionals treat dialysis patients and lead longer, more comfortable lives.

At American Endovascular affiliated centers, the physicians constantly strive to exceed the highest standards of clinical excellence. Their dedication to patients has earned the American Endovascular affiliated centers the prestigious Joint Commission Accreditation, the industry’s gold standard for certification.

The Joint Commission is an independent, non-profit group that administers voluntary accreditation programs for hospitals and healthcare organizations. Joint Commission Accreditation is recognized as a symbol of quality that reflects a commitment to meeting and maintaining high-performance standards.

Additionally, American Endovascular affiliated centers provide:

  • Board Certified Endovascular & Interventional Radiologists
  • Personalized care in a welcoming environment
  • Same-day scheduling
  • Minimally invasive-image guided treatments and procedures
  • Transportation coordination available (inquire at individual locations for details)

Thanks to Dr. Rundback, I can do the things I took for granted. My life changed drastically when the plaque clogging my blood vessels made walking unbearable. For instance, I would walk two or three blocks and feel my legs cramping up and forcing me to stop walking while the pain subsided. Moreover, my legs felt heavy and lethargic. Now my legs feel great post-procedure with no more cramping or that heavy feeling. Thank you, Dr. Rundback for returning the smile and happiness that eluded me for the past two years. Quality of life isn’t everything. It’s the only thing!

Ernie P.

I love Dr. Rundback. They are great. Dr. Rundback is very caring and he saved my legs. He is a very good worker, my previous Endovascular said there was nothing they could do for me. I would recommend him to anyone. I have been working with Dr. Rundback for over a year and I have had a great experience

Delores L.

My experience here was absolutely phenomenal. I think the treatment here and the employees here are absolutely incredible.

Robert D.

Dialysis Access procedures performed by American Endovascular Affiliated Physicians

Procedures include:

  • Fistula Maturation: After a fistula is surgically created, the artery and veins experience new hemodynamic forces that cause a change in blood flow. As a result, the blood vessels change in diameter and arterial walls become thickened to accommodate the new blood flow. This remodel is known as fistula maturation. However, there are times when the newly created fistula does not remodel as it should. When that happens, physicians can employ a range of endovascular techniques such as angioplasty to help the fistula get to the place it needs to be in order to handle the endovascular demands of dialysis.
  • Dialysis Catheter Placement: Certain times, due to age, health, or other factors, a patient is unable to receive a fistula or graft. When that occurs, physicians can insert a permanent or temporary catheter— providing direct access for dialysis—in either the chest or top of the thigh.
  • Thrombolysis & Thrombectomy:  There are times when fistulas and grafts can narrow and become thrombosed due to a buildup of blood clots from routine use. Physicians can work to clear the blocked access using thrombolysis and thrombectomy. Thrombolysis involves injecting a medicine into the clogged access, breaking down and dissolving the clots. Thrombectomy is a minimally invasive endovascular procedure where the blood clot is physically removed, or macerated, clearing the access for dialysis treatment.
  • Angioplasty & Stenting: One of the most common treatments for fistulas and grafts is angioplasty. An area of narrowing can occur in the fistula or graft due to regular use.  Angioplasty works to stretch the narrow portion of the access by inserting a catheter with a small balloon and inflating it to reopen the vessel. This treatment restores optimal flow so the patient can receive dialysis treatments. In situations where angioplasty is not effective, a stent—a small wire mesh tube—is inserted to keep the vein or artery open, optimizing flow in the access.
  • AV Fistula Banding: AV Fistula Banding is a technique performed by licensed physicians on patients with Steal Syndrome. This syndrome, occurring in roughly 1% of fistulas and 5% of grafts, occurs when a fistula or graft has such high blood flow that it can actually “steal” blood from the hand, causing numbness and pain.  Banding lowers the blood flow in the fistula, delivering more blood to the hand.

If you or someone you know is experiencing problems with dialysis access, schedule an examination at an American Endovascular affiliated center today to speak with a medical professional. American Endovascular affiliated physicians are well-versed in the latest procedures and techniques for Dialysis Access Management and are ready to help.

Seriously, I’ve worked 15 years in dialysis and have never met a group that is as involved with the unit as Queens Endovascular Center. It really makes a difference to me and the patient’s life. Please continue, that’s why I refer almost all my patients to you! Don’t change because wherever I go I will recommend you.


American Endovascular doctors are the leading experts in dialysis access