Vascular/Dialysis access creation and revision 

Patients with chronic kidney disease or kidney failure who require hemodialysis need a reliable and safe way to access the bloodstream. Dialysis access surgery creates a pathway through which blood can be removed from the body, filtered by a dialysis machine, and then returned to the circulation.

A well-functioning vascular access is essential for effective dialysis treatment. Vascular surgeons specialize in creating, maintaining, and repairing dialysis access to ensure long-term reliability and minimize complications.

What Is Dialysis Access?

Dialysis access refers to a surgically created connection that allows repeated entry to the bloodstream for dialysis treatments. Because dialysis must typically be performed several times per week, the access must be durable, safe, and capable of providing adequate blood flow.

There are three main types of dialysis access.

Types of Dialysis Access

Arteriovenous (AV) Fistula

An arteriovenous fistula is created by surgically connecting an artery directly to a nearby vein, usually in the arm. This connection increases blood flow through the vein, causing it to enlarge and strengthen over time.

AV fistulas are generally considered the preferred and most durable type of dialysis access because they:

  • Last longer than other access types
  • Have a lower risk of infection
  • Provide excellent blood flow for dialysis
  • Have fewer long-term complications

However, fistulas require time to mature before they can be used for dialysis.

Arteriovenous (AV) Graft

When a patient’s veins are not suitable for a fistula, a synthetic graft may be used to connect an artery to a vein. The graft acts as a bridge between the vessels and can be accessed with dialysis needles.

AV grafts:

  • Mature faster than fistulas
  • Provide reliable dialysis access
  • Are useful for patients with smaller or damaged veins

However, grafts may have a higher risk of infection or clotting compared to fistulas.

Central Venous Catheter

A central venous catheter is a tube placed into a large vein, typically in the neck or chest. Catheters are usually used as temporary dialysis access when dialysis must begin immediately or while waiting for a fistula or graft to mature.

Because they carry a higher risk of infection and complications, catheters are typically used only as a short-term solution.

Dialysis Access Creation

Before creating dialysis access, the vascular surgeon performs a detailed evaluation of the patient’s blood vessels. This may include:

  • Ultrasound vein mapping
  • Vascular examination
  • Assessment of arterial and venous blood flow

The goal is to select the best possible access site that will provide reliable dialysis while preserving future access options.

Access creation procedures may include:

  • AV fistula creation
  • AV graft placement
  • Central venous catheter placement when needed

Dialysis Access Revision and Maintenance

Over time, dialysis access can develop complications that interfere with proper blood flow. When this occurs, revision procedures may be required to restore or maintain function.

Common access problems include:

  • Narrowing of the blood vessel (stenosis)
  • Blood clot formation (thrombosis)
  • Infection of the access site
  • Poor maturation of a fistula
  • Aneurysm formation in the access vessel
  • Reduced blood flow during dialysis
  • Difficulty placing dialysis needles

Access Revision Procedures

To correct these issues, vascular surgeons may perform procedures such as:

  • Angioplasty to widen narrowed vessels
  • Thrombectomy to remove blood clots
  • Surgical revision of a failing fistula or graft
  • Superficialization or transposition of veins to improve access
  • Replacement of malfunctioning grafts
  • Creation of a new dialysis access site

These procedures help prolong the life of the dialysis access and ensure patients continue receiving effective dialysis treatment.

Importance of Long-Term Access Care

A well-maintained dialysis access improves the quality and effectiveness of dialysis therapy. Regular monitoring, early detection of complications, and timely intervention by a vascular specialist can significantly reduce the risk of access failure.

Patients are encouraged to report any changes such as swelling, pain, reduced blood flow during dialysis, or signs of infection so that prompt evaluation can be arranged.

Our Approach

Our practice offers comprehensive dialysis access services, including access planning, creation, monitoring, and revision. By combining advanced imaging techniques with modern surgical and endovascular treatments, we aim to provide durable dialysis access and improve long-term patient outcomes.

Scroll to Top