What are the different dialysis access procedures that are performed by American Endovascular? [Dr. Spinowitz]

Q: What are the different dialysis access procedures that are performed by American Endovascular?

A: I’d like to start from the beginning of the dialysis treatment for a patient.

If a patient is requiring dialysis and they do not yet have a fistula or a graft, they may require a hemodialysis catheter or a peritoneal dialysis catheter. The hemodialysis catheter is placed in the internal jugular vein, thereby allowing for adequate flow into the dialysis machine to clean the blood. Another possibility is for a peritoneal dialysis catheter to be placed.

A peritoneal dialysis catheter is placed into the abdomen, allowing dialysate which is a fluid which is allowed to enter the abdominal cavity acting like a sponge, removing the extra fluid and waste and toxins and retaining electrolyte balance through the fluid rather than through a hemodialysis machine, removing the blood from the patient.

The more common types of dialysis access include fistulas and grafts. A fistula or a graft can be created at our offices.

A fistula is a connection between the patient’s artery and the patient’s vein. This is the more natural of the two kinds of dialysis access as the patient does not have any foreign body introduced. This is a connection between the patient’s own artery and vein, although this is still unnatural for the body.

If the patient does not have a suitable vein for a fistula, a graft can be inserted. A graft is an artificial tube which is connected to the artery on one side and to the vein on the other, to allow for dialysis.

A fistula is only considered mature once there is enough flow into the fistula. The fistula is of adequate size to avoid difficulties with cannulation, and there is sufficient venous outflow back to the central venous circulation to avoid high-pressure systems.

During the maturation process, each part of the system needs to be addressed. For example, we address the arterial inflow, whether it’s the artery or the connection, and the arterial anastomosis between the artery and the vein. If that needs to be made larger, we can use angioplasty. If there is not enough flow into the main body of the fistula there may be small veins called collateral vessels draining the blood away from the main body of the fistula. Those collateral vessels can either be ligated, which means to be tied off, or undergo coil embolization, which is to put a small metal thread into those small collateral vessels, ensuring all of the flow coming from the artery stays within the main body of the fistula.

After that point, the vein needs to be able to be drained back toward the central circulation, and that is where we may use angioplasty or stent placement, or flow re-routing, which means to make a new path toward the central circulation. Ultimately we restore adequate flow from the artery, through the fistula, and back to the heart enabling clearance and cleaning of the blood for dialysis.

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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