If you have kidney failure, your kidneys cannot cleanse your blood of wastes, urea, and extra fluid. Dialysis & hemodialysis are necessary if your kidneys fail, and unless you have a successful kidney transplant, you’ll need this therapy to help your body clean and filter your blood. The first step in hemodialysis is access, which our fellowship-trained vascular surgeons specialize in.
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Hemodialysis is a procedure that uses a specialized machine to withdraw blood from the body. With the help of a dialyzer (a special membrane), wastes and extra fluid are filtered and removed from your body. Hemodialysis also restores the electrolyte balance in your blood.
Your provider may start you on hemodialysis when the signs and symptoms of kidney failure appear. These signs include:
A buildup of urea and other wastes in your body occurs when your kidneys are unable to eliminate wastes. When these wastes reach high levels, they are poisonous and can cause life-threatening symptoms.
Dialysis and hemodialysis can cause low blood pressure, an irregular heart rhythm, and other problems that may exacerbate your kidney failure. Your provider and care team will do everything possible to keep you safe during your dialysis.
To start you on hemodialysis, we need a way to access your blood circulation–we call this vascular access. There are three types of vascular access used for hemodialysis:
The best type of access for your body will depend on several factors. Your vascular surgeon will use your medical history, your veins, and how your kidney failure is affecting you to choose the correct access for your body.
The CVC is a flexible plastic tube shaped like a y and threaded through your skin into a central vein in your chest, groin, or neck. This is not a permanent access type and is best utilized if you need emergency or immediate dialysis.
The advantages of a CVC include that it’s quick to place and remove, it can be used immediately, and that is done as an outpatient procedure. Its disadvantages include potentially damaging central veins, it may increase the time of your hemodialysis treatment, you should not bathe or swim with a CVC, and you can face infection or catheter clotting.
An AV fistula is a surgical connection made between one of your arteries and a vein. Typically, AV fistulas are made in your non-dominate arm, but they can be created in your leg. Often referred to as the “gold standard,” of hemodialysis access, AV fistulas result in an increased blood flow rate through the vein, which works to enlarge and strengthen your vein.
An AV fistula can function for years but may require another temporary type of access as it heals and matures. It is not as likely to become infected or clot but does require needles for hemodialysis. While it’s considered the best option, your provider will ensure it’s the best option for you.
AV grafts function similarly to AV fistulas and are an option if you have veins that are damaged, blocked, or too small for a fistula. During this surgical procedure, your vascular surgeon will connect one end of a small, hollow, synthetic tube to your vein and the other end to your artery.
AV grafts are easy to implant, are typically ready to use in 3-4 weeks, and their placement is an outpatient procedure. AV grafts do not last as long as AV fistulas and are prone to clots, and require needles to access the graft.