What are some complications that can occur to a dialysis access patient? [Dr. Spinowitz]

Q: What are some complications that can occur to a dialysis access patient?

A: After the fistula or graft is up and running, it will, in most cases, require maintenance. The scar tissue or narrowing that caused many of the difficulties, to begin with, doesn’t just go away after one angioplasty or a stent. Sometimes the narrowing will return. The unnatural state is there 24/7. Every time the heartbeats, it’s running through the vein or the graft, which is not how nature intended.

The scar tissue can build up, sometimes between three and six months, causing difficulties at dialysis. Some of the difficulties can lead to high-pressure complications. Some complications can arise with cannulation when you’re trying to stick an access to the fistula or graft. Other complications can include prolonged bleeding when they remove the needle from the access.

If there is high pressure, the blood will come out of that hole from the dialysis needle. We have to make sure that there is decreased pressure and avoid this bleeding complication. Other difficulties and pain for the patient can come from this high pressure causing poor healing or ulceration at the cannulation site. Some of the more central narrowing can cause swelling and cramping for the patient. If the narrowing within the arterial inflow or the venous outflow is severe, there may not be enough flow through the fistula or graft, and the graft can clot. The patient would be referred for a thrombectomy, which is a procedure to remove the clot and to repair the cause of the thrombosis.

Another complication can be something called steal syndrome, where the access is stealing blood away from the hand. If there is too much flow coming into the access, there is not enough flow going down to the hand.

This would cause numbness, stiffness, and cramping for the patient. In order to remedy that problem, we would actually make the inflow a little smaller. So just after the connection between the artery and the vein or the artery and the graft, we would make that area a little smaller, decreasing the amount of flow into the access and improving blood flow down to the hand. When there is steal syndrome, the patient would benefit from a banding procedure where we would decrease the amount of flow into the access and improve flow down to the hand, improving their symptoms. These are just some of the dialysis access procedures that are performed here at American Endovascular.

More videos from the interview with Dr. Spinowitz of the Queens Endovascular Center as he explains the Dialysis Access Management process:

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