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What is Dialysis?

Those who suffer from kidney failure need to visit their doctor to receive dialysis. Dialysis serves as a substitute for many of the functions of a kidney. It helps to regularly clean and filter your blood to prevent waste from building up. Depending on the severity of kidney failure, patients may only have to receive dialysis treatment a few times.  However, if the failure is severe, they will have to visit their doctor for dialysis every few days to complete daily activities.

Dialysis requires access to blood vessels. If there is no entryway to a blood vessel, there is no way for the dialysis to enter the bloodstream. There isn’t a way to naturally reach and open a blood vessel, so dialysis access is a required procedure for patients who are suffering from kidney failure.

Types of Dialysis

Hemodialysis

Hemodialysis filters your blood through a dialysis machine. Once you are connected to the machine via your hemodialysis access, blood flows into the machine, gets filtered and is returned to your body. There is a choice in where you do hemodialysis and who performs the treatment. In-center hemodialysis is performed by a trained team of nurses and technicians. At-home hemodialysis can be performed in the comfort of your own home, either with the help of a care partner or on your own.

Peritoneal Dialysis

Peritoneal dialysis uses the blood vessels in the lining of your abdomen—the body’s natural filter—along with a solution called dialysate to filter blood via a peritoneal catheter. With this method, blood never leaves your body. At-home peritoneal dialysis can be done with a machine or manually at home, at work or even while traveling. Peritoneal dialysis is an alternative to hemodialysis. For patients who cannot tolerate hemodialysis, or select PD as their treatment option, a PD catheter is the only option for access.

Types Of Dialysis Access

Central Venous Catheter (CVC)

A central venous catheter (CVC), which is a flexible, long, plastic, y-shaped tube that is threaded through your skin into a central vein in your neck, chest or groin. A CVC is not usually intended to be a permanent type of access. If you need immediate or emergency dialysis or cannot receive and don’t have an AV fistula or graft, you will require a CVC.

Peritoneal Dialysis Catheterization

A PD catheter is used for peritoneal dialysis, which uses the lining of your belly and a dialysate solution to clean your blood.This type of dialysis can be a desirable method for people who are always on the go. With a PD catheter, dialysis can be performed at home and takes less time to accomplish.If you are unable to care for yourself, have an abdominal hernia or inflammatory bowel disease, recurring diverticulitis or large surgical scars on your belly, peritoneal dialysis and the PD catheter may not be an option for you.

Fistula

A fistula takes a piece of a vein from your arm or leg and sews it into a nearby artery. Therefore, an artery is joined with a vein. This allows the sewn-in vein to enlarge and become thicker. This is considered a very safe option because it has a low risk of infection.When a fistula is created, the surgeon can either divide the vein and sew one end to the side of the artery or sew the two vessels side-to-side without having to divide the vein.

 

 

Graft

A prosthetic graft can be sewn between an artery and a vein in your arm or leg. This option is typically preferred if your veins are too small for a fistula.

 

 

 

 

Dialysis Access Repair

All types of vascular access can develop complications including infection or low blood flow due to narrowing blood vessels.  When your access isn’t performing optimally during dialysis, you may need to see a vascular specialist for dialysis access management so that you may continue with your dialysis treatments. The Access Center at Savannah Vascular  Institute offers access repair for those who need to fix complications in their fistula or graft. Access interventions, including a fistulogram, angioplasty, stent placement, thrombolysis and/or thrombectomy, may be performed to improve or restore your access’s blood flow.

 

Fistulogram

If an AV graft or AV fistula is not functioning well during hemodialysis, a fistulogram may be performed. During this minimally invasive x-ray procedure, IV contrast is used to view the access and identify areas where the blood vessel is too narrow (stenosis), abnormally enlarged (pseudoaneurysm), or partially or completely blocked (clotted).

Angioplasty

If abnormal narrowing (stenosis) is seen during the fistulogram, further dialysis access management is needed. An AV graft or fistula may be treated with angioplasty, a minimally invasive procedure used to widen a narrowed portion of the fistula or graft to restore the blood flow to the desired rate.

Stent

Stent placement, another minimally invasive dialysis access management procedure, is sometimes performed in conjunction with angioplasty. A stent is a small, wire mesh tube that expands to hold the affected segment of the blood vessel open if angioplasty alone isn’t successful, and then remains in place after the procedure, allowing for improved blood flow.

Thrombolysis/Thrombectomy

Blood clots form for a variety of reasons and disrupt blood flow. Even under the best of care, it is possible for your dialysis access to become blocked. Thrombolysis and thrombectomy are minimally invasive procedures that our vascular specialists at Savannah Vascular Institute perform to treat and remove a blood clot from your dialysis access.
Thrombolysis, also known as thrombolytic therapy, is the use of drugs as treatment for the breakdown (lysis) of blood clots that have blocked your dialysis access. This treatment involves the injection of clot-busting drugs through a catheter to deliver drugs directly to the site of the blockage.
Thrombectomy utilizes an angioplasty balloon catheter, and perhaps a specialized mechanical device to break up and remove the blood clot from the fistula or graft
These procedures will allow us to evaluate your access site, find out why it is not working properly, treat the problems and restore the function.

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