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What is 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.

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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. The following are three common methods of dialysis treatment.

AV Fistula

An AV fistula is 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

An AV graft is 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

A vascular 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.

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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.

Dialysis Access Procedures Performed by American Endovascular Affiliated Physicians

American Endovascular’s affiliated vascular centers offer multiple treatment options to prolong the life of fistulas and grafts, diminishing the need to put patients through multiple access surgeries. Our affiliated physicians specialize 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. 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.

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What to Expect from
Dialysis Access Management

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Same Day Procedure
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No Hospital Stay
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Minimally Invasive-Image Guided Treatments and Procedures
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Personalized Care in a Welcoming Environment

Dialysis Access Management FAQ

What are the Three Types of Dialysis Access?

There are three different types of vascular access that can be placed for hemodialysis. They are called a fistula, a graft, and a catheter.

How Do You Take Care of Dialysis Access?

Whether your vascular access is a fistula, graft or catheter, you need to make sure you take care of it. With a fistula or graft, you want to make sure that you wash them with antibacterial soap before dialysis. You also want to check for redness on any area of your access and report it to your care team. With a catheter, you want to ensure that the catheter dressing is kept clean and dry. Also, you want to make sure that the access is cleaned and the dressing is changed by your team at each dialysis visit.

What is the Golden Standard of Dialysis Accesses?

In terms of overall performance, an AV fistula is often considered the “gold standard” for vascular (hemodialysis) access. It is associated with fewer infections and fewer hospitalizations since it tends to last longer than other access types.

Our Vascular Centers in NY & NJ

American Endovascular has vascular centers in New York and New Jersey. Our centers offer patients streamlined outpatient care with the latest minimally invasive-image guided technology.

Brooklyn, NY
71 Carroll Street
Brooklyn, NY 11231
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Queens, NY
28-18 31st Street
Queens, NY 11102
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Harlem, NY
505 East 116th Street
Harlem, NY 10029
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West Orange, NJ
347 Mount Pleasant Avenue
West Orange, NJ 07052
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What Our Patients Are Saying

First Impressions are lasting impressions! First, the staff are phenomenal! How is it possible that each and every one of them are incredibly kind, caring, professional, personable and treat you like you are THE most important person in the world!? Well, meet this team for an experience that will make you feel valued as a person, not just as a patient. In walks this amazing Doctor and now you understand why his team are the way they are! They regard each other with the utmost respect, and kindness, and they communicate with each other like family. And as a new patient, I had the honor and pleasure to experience excellence in patient care and concern. I am so very grateful to have found a Doctor who is in my opinion perfect with a team who are exceptional! I’m excited for my next visit, honestly! I write this with a great big Smile on my face!
CC (Moon)
CC (Moon)
20:47 02 Mar 24
I felt very comfortable with him. Excellent bedside manner, proper teaching , and knowledgeable. I highly recommend him!
Jamel Jackson
Jamel Jackson
14:07 27 Feb 24
Yes it was a good place
Carmen Diaz
Carmen Diaz
14:22 20 Feb 24
The absolute BEST Dr!! Detailed, caring & kind! The best medical procedure I’ve ever had from consultation to post procedure, perfect! 10s all around 👏🏽👍🏽👍🏽 many thank yous🙏🏾
Josi W
Josi W
22:04 12 Jan 24
Excelente servicio es lo mejor que me a pasado gracias a sus buenos tratamiento ya no tengo dolor
Is good to be with friendly and professional staff at doctor’s offices like this one.
Dr. Joseph Sham and the entire Team were very professional, knowledgeable, informative and had incredible patience with me by answering all my questions and concerns. Great Team…Thank you all! 👍
Marion
Marion
22:17 27 Dec 23
I was treated very well. The staff was very professional and made me feel comfortable. Looking forward to my next visit.
Stephen Lapinsky
Stephen Lapinsky
20:17 20 Dec 23
This experience was great I’m so happy with everything
stephanie suazo
stephanie suazo
22:53 13 Dec 23
Excellent, professional, organized and efficient all best describes the service here.
Delsi Cunningham
Delsi Cunningham
00:41 06 Dec 23
Love this Dr and staff. They are all kind courteous and professional with excellent medical care. I would highly recommend them to anyone in need.
Sybil Wilkins
Sybil Wilkins
21:58 28 Nov 23
I love this place stuff is helpful an they all were nice. I had a wonderful experience Dr Shams was great.
Victoria Pacheco
Victoria Pacheco
22:07 17 Nov 23
Professional services
Ricky Mo
Ricky Mo
22:14 15 Nov 23
I like the doctor they were kind of pretty thorough he says that he could help me he found out the filter in my abdomen from the surgery I had in 1996 has been clogging my blood flow for 25 years and that’s causing the swelling at every other doctor told me was lymphedema it was not lymphedema it caused the lymphedema because no other doctor took the time or care enough to find out the reason for my leg swelling this doctor was the only one who finally found out and he’s going to see if you could put a stent inside the filter to open it up and and stop my legs from swelling hopefully this will all go good it hasn’t happened yet but I’ll keep you posted thankful for this docto I just pray and hope that it works otherwise I like the doctor very much
Mitchell Dedios
Mitchell Dedios
21:01 27 Oct 23
Excellent service , good customer service and friendly staff. Thanks
Raysa Polanco
Raysa Polanco
20:54 27 Oct 23
You may likely have to wait. Avoid anxiety and frustration. Schedule extra time for the visit. Allow for personal attention to your care needs once in the examination room. Friendly, nice staff and doctor puts you at ease. Bottom line: worth the wait!
Sisle Heyliger
Sisle Heyliger
21:49 26 Oct 23
Very nice and friendly staff.I was so nervous, they all made me feel relaxed and comfortable.They explained everything to me step by step.
Keith Dickens
Keith Dickens
21:18 23 Oct 23
Excellent service and staff i’ll let you feel relaxing and comfortable
kadine campbell
kadine campbell
21:01 23 Oct 23
Sheer perfection. The care and expertise and teamwork are the best I have ever experienced. I’m a former nurse and I recognize and give a shout out to the best!!!!
Barbara Murray
Barbara Murray
20:49 10 Oct 23
I was given good advice about my blood circulation
Gary Jackson
Gary Jackson
17:04 08 Oct 23
Dr. Shams office is amazing. Whitney and Angela were AMAZING. Great sense of humor. Staff is WONDERFUL.
Sara Correa
Sara Correa
21:13 18 Sep 23
Nice office, personnel friendly, & caring, good informative information concerning my care.
Loretta Johnson
Loretta Johnson
21:26 22 Aug 23
Really like this doctor, talks in your language, just over all regular nice person.
Linda Thoomey
Linda Thoomey
22:03 21 Jul 23
I’m very satisfied of my visit for the first time, everyone was concerned about me, and Dr David was very patient to listen to my long health stories, after that He gave me good explanation for my problem, that was great 👍
Claude Jean Pierre
Claude Jean Pierre
22:38 18 Jul 23
Follow up to a procedure. Dr Mobley and his staff are great and always helpful
DanLiza Diehl
DanLiza Diehl
21:25 10 Jul 23
David monkey,MD and the grupo are excellent very kind and helpful.i will return to them.the attention.its very satisfied.thank u ..
Luis Sarria
Luis Sarria
12:16 29 Jun 23
I had a good experience with my procedure and Dr. Mobley’s follow-up calls are great. I’ve never had a doctor who has been so concerned about following up after a procedure to see how I’m doing and if there are any post-procedure problems I may have experienced (which there aren’t). I’d highly recommend Dr. Mobley.
Hey Beej
Hey Beej
16:42 23 Jun 23
Dr Mobley was so helpful, informative and made me feel secure in making my future medical plan. Supportive and kind. Highly recommended.
Amanda L Browder
Amanda L Browder
15:57 23 Jun 23
Doctor was very thorough. Explaining what the procedure is all about. Tell me what I could realistically expect. Couldn’t have asked for a better consultation. Highly recommended if you have a prostate issue
John Buric
John Buric
16:26 15 Jun 23
I was very pleased and satisfied on how Dr. David Mobley examined me and explained everything on what I need to know regarding my condition. He’s very professional and knowledgeable in all aspects of his profession. I would highly recommend him to my other friends!
Celine Parcon
Celine Parcon
23:16 07 Jun 23
Dr Shams was very attentive and explained everything in detail. The staff was very nice, the staff/nurse were all so very helpful, It was a Monday morning and I didn’t expect such happy staff.
Stacy Lebeau
Stacy Lebeau
21:22 06 Jun 23
He puts his patients before himself, returning calls and e-mails quickly. Not only is he kind and considerate, he is an excellent physician. I had to have a procedure that requires me to be awake, and he talked me through it and kept me at ease. If I could give him more stars, I would.
Super friendly, tentative, once in the procedure rm the sx staff made you feel comfortable, easy,+ answered all questions. David mobley, MD answered all my questions, very informative, caring. I felt confident in his care
Thais Bini
Thais Bini
21:22 30 May 23
Great doctor. Everyone is so kind and caring. Great place to go
Joan Jurica
Joan Jurica
14:46 30 May 23
Good service!
Veronika Shopina
Veronika Shopina
21:09 24 May 23
There is a friendly atmosphere, fast medical attention and an advanced medical equipment !!!The Staff is very knowledgeable and the best care possibly !!!100 % Satisfied !!!
Cruz Figueroa
Cruz Figueroa
03:06 08 May 23
Whole staff was very friendly and professional. I feel confident that I came to the right place for treatment.
Rudy Padilla
Rudy Padilla
02:08 13 Apr 23
The best in Astoria I recommend Dr mobley and staff 100 percent
michaela1951
michaela1951
21:25 30 Mar 23
Knowledgeable , experienced, great bed side manners
mohamed hamed
mohamed hamed
10:09 30 Mar 23
I am pleased w/my experience @ endovascular. I hope they can save my foot.
Margo A Williams
Margo A Williams
19:19 29 Mar 23
This has been the best medical experience I’ve had in over thirty years. I was nervous to have a procedure after only knowing about my condition a year ago. They made this process so easy for me that I’m in shock that I had no pain, no discomfort thanks to an excellent doctor and professional staff! Thank you all and best of luck to your practice.
Stacey Marius
Stacey Marius
14:16 29 Mar 23
The doctor was very nice and professional. He explained the tests that I need and why I need them.
Judith AndersonNeal
Judith AndersonNeal
22:12 27 Mar 23
This was the best experience I have had in such a long time and I have had quite a few procedures in the past both in patient and out including the procedure I was currently present for. No other surgeon has been so kind, transparent, and gentle. Not only did he personally come out beforehand to provide me with education on my procedure, but he talked me through every step of the way and made me feel so comfortable and relaxed. Not to mention his amazing staff! Despite being extremely nervous they kept me smiling and laughing throughout the whole process. 10/10 would recommend. Thank you so much guys!!
Riah L.
Riah L.
13:49 22 Mar 23
Excellent bedside manners and the procedure was a breeze.
sen-pei hsia
sen-pei hsia
18:26 20 Mar 23
Los mejores/ the best💖🙏
Ruthy Ochoa
Ruthy Ochoa
04:17 03 Mar 23
Excellent, Patience, don’t Rush you to be finished. The Doctor explains everything and answers your questions. I would Recommend Dr.Sham service anytime, they are. Great!
Debra Farmer
Debra Farmer
00:16 01 Mar 23
I went with my mom who just had a hip surgery. The whole team was very caring, nice and very professional. I did appreciate that the surgeon took the time to explain to me what was wrong with my mom’s arm and what he did to fix it.
mouna khalyat
mouna khalyat
14:37 24 Feb 23
Very good and very responsive.
James Young
James Young
19:33 22 Feb 23
Although I didn’t meet with the doctor, the receptionist, assistant and nurse were great.
Theresa Gaines
Theresa Gaines
13:25 13 Feb 23
Every thing and the process are being done properly ..Terissa you are very Carey ..thank you so much every body are very polite and very professional.. Thank you so much to Dr.Mobley..God blessed you all .🙏🙏🙏👍
Remigio Ruda
Remigio Ruda
03:28 31 Jan 23
Very knowledgeable, personable and professional. I came to Dr. Mobley to correct another surgeons work and I was pleased with the outcome. There is a Hispanic woman that runs things in the O.R.She is great! The whole staff is wonderful and caring.Highly recommend
Lakesha Kingdom
Lakesha Kingdom
15:57 17 Jan 23
I had a wonderful PA take care of me, & the nurses were very sweet. I was happy with my visit
Aurora Anello
Aurora Anello
19:20 10 Jan 23
Everything always goes well.staff are very caring.
Lillian Rodriguez
Lillian Rodriguez
19:00 11 Dec 22
Excellent Doctor he explains the procedure process so that it is understandable and comfortable for the patient!
T. J.
T. J.
14:48 06 Dec 21
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