Vascular access is required for dialysis to access the circulatory system of the body and allow the blood to flow into the machine for dialysis. Three different types of access that can be placed for dialysis are a catheter, a fistula, and a graft.
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AV Fistula: AV fistula is one of the preferred dialysis accesses due to its long life and few complications. It is a connection made between the arteries and veins through surgery. It is generally placed in the arms. However, the doctor may consider placing it in the legs if needed.
Salvage of Failing Fistula: Maturation of the AV fistula is required to use it for hemodialysis. Characteristics of a matured fistula are good blood flow and vein arterialization. Fistula fails to mature due to several reasons such as stenosis, intimal hyperplasia, and multiple collaterals in connected veins. Salvage measures include surgical ligation, angioembolization, percutaneous transluminal angioplasty, and surgical stenosis resection.
Salvage of Occluded Fistula: During an occluded fistula, one of the blood vessels connected to the fistula narrows, resulting in reduced or absent blood flow to the fistula. It is generally due to blood clots. The treatment depends upon the severity of the clot and may comprise thrombectomy, medications, and angioplasty with or without stenting.
Basilic Vein Transposition: This procedure is used for accessing the upper extremity for hemodialysis. The basilic vein is selected as it is larger than the cephalic vein.
AV Graft Placement: The AV graft connects the arteries and veins and is used for hemodialysis access. This procedure is performed under anesthesia and involves making two small incisions to access the artery and vein.
Permacath Placement: This technique is usually used for short-term dialysis treatment. The technique involves inserting the special intravenous line in the upper chest or neck, under the collarbone.
Central Vein Angioplasty: One of the major challenges in hemodialysis is central venous obstruction and stenosis. A Central vein angioplasty is performed to remove the obstruction from the central vein.
Fistuloplasty: Fistuloplasty is the procedure to remove the blockage from the AV fistula. A special device removes the blockage by inserting a deflated balloon and then inflating the balloon in the fistula.
