Providing hemodialysis access care in much more than simply creating the access—catheter, fistula or graft. It requires creating a long-term plan for the patient that is individualized based on the anatomy and other medical problems that the person faces. The utilization of our Noninvasive Vascular Laboratory is, in many respects, the key to our success. Our trained Vascular Technologists have an acute understanding of the dialysis access needs of our patients and are able to identify options that many others have not recognized. Many of our patients are referred to us from other surgeons who see no options to a catheter. We, typically, are able to construct an access (AVF or AVG) that eliminates the need for a catheter.
The initial evaluation occurs with a history and physical examination to identify the other medical conditions that a patient has in addition to examining the patient’s arteries and veins. This is then complimented by a thorough ultrasound examination where we can assess the quality of the arteries and veins deeper in the arm. Not infrequently, we are able to find veins that may not have been present on simple physical examination. Understanding the anatomy of the arteries and veins allows us, as specialists in artery and vein disease, to create an appropriate access that is designed to last a long time as the lifeline for the patient with kidney failure.
Creation of dialysis access, as stated above, requires a long-term plan that is necessarily individualized for each patient. Three basic options exist—Arteriovenous Fistula (AVF), Arteriovenous Graft (AVG) and Catheters. AVF and AVGs allow for two needles to be inserted (one to bring blood from the patient to the dialysis machine and the second to return the cleansed blood from the machine back to the patient.
Both of these are preferable to the placement of a catheter which has two tubes coming from the body that can hooked directly to the machine itself.
Hemodialysis Treatment May Include
The best AVF and AVG will, eventually begin to fail. The improvement in care of the patient in need of hemodialysis has resulted in patients living longer with their dialysis access. The longer an AVF or AVG is in place, the more scar tissue that builds up within the access causing the access to function less well. When this occurs, the dialysis treatment becomes less effective and the patients become to feel less well. Often, patients will encounter problems while their dialysis session is going on—such as the alarms on the machine sounding indicating poor pressures in the access—or they may encounter excessive bleeding when the needles are removed. Occasionally, the access may stop working altogether and the patient is left with no means of receiving hemodialysis. When this occurs, our specially prepared Procedure Suite in our office is able to immediately accommodate patients and restore their lifeline back to a state allowing them to receive dialysis treatment.
Understanding the entire access process sets The Cardiovascular Care Group apart from many others who purport to be experts in the management of dialysis access. We are able to minimize the interventions performed, limit our use of devices such as stents in this patient population and, when required, are able to create a new access for the patient in need.