Kidney Failure Treatment
Treating Patients in Northern Dallas
For End Stage Renal Disease (ESRD) patients, their dialysis access is their lifeline.
At North Texas Vein and Vascular we understand this. That’s why we will make the extra effort to optimize each patients hemodialysis access, whether they have a fistula, graft, hemodialysis catheter, or peritoneal dialysis catheter.
Dialysis Catheter Placement and Removal
Sometimes a patient is put on hemodialysis before there is enough time to place a fistula or graft. When this happens, a tunneled dialysis catheter (sometimes called a Permcath) can be placed. This catheter is placed into one of the veins of the neck and then is “tunneled” under the skin a short distance to an exit site in the upper chest, normally about 2-3 inches below the collar bone. The catheter can be used for hemodialysis immediately after placement. The catheter can later be removed after a fistula or graft has been placed and the fistula or graft is mature and ready to use for dialysis.
Dialysis Fistula/Graft Angioplasty, Stenting, and Coil Embolization
Almost every arteriovenous fistula or graft will at sometime start to function poorly, normally due to a stenosis (narrowing) of the outflow vein. The most common symptoms can include high venous pressures at dialysis, prolonged bleeding after removing the needles, poor quality dialysis, and arm swelling. The life of the access can be prolonged by opening up the stenosis with a balloon. This is called balloon angioplasty. If the blood vessel will not stay open by just using balloon angioplasty, a small metallic wire tube, called a stent, may have to be placed.
Sometimes there is a large vein that is “stealing” blood flow from the main part of the fistula, thus reducing the flow in the fistula. This can make dialysis less efficient. When this is seen, most of the time they can be closed with small flexible metallic coils so that the blood flow remains in the fistula.
Dialysis Fistula/Graft Thrombolysis
When a dialysis fistula or graft starts to function poorly, it may stop flowing altogether. This is called a thrombosed fistula or graft. Most of the time the dialysis access can be salvaged if treated immediately. Removal of the blood clot from the fistula or graft can be accomplished by using a special medicine injected into the access to dissolve the clot and also with a variety of mechanical devices intended to remove the blood clot. Most of the time there is a stenosis (narrowing) in the fistula or graft that has become tight enough to completely close it down, and this will also be treated with angioplasty and possible stent placement.
Dialysis Fistula Balloon Assisted Maturation
For a hemodialysis fistula to be used, it must have some time to mature after placement. This time frame is anywhere from 2-4 months. This allows the outflow vein to dilate to a size that is usable for dialysis. When the fistula fails to mature in a timely manner, it can be studied and sometimes be salvaged and made usable through a series of angioplasty procedures called balloon maturation. This normally takes about 2-3 visits over 4-6 weeks.