Schedule an initial consultation at one of these locations:

Utah Vascular Clinic

801.281.0027

650 East 4500 South, Suite 100
Salt Lake City, UT 84107

Ogden Regional Medical Center

801.479.2450

5475 South 500 East
Washington Terrace, UT 84405

Services

Vascular

Dialysis Access

What is dialysis access?

An dialysis or "AV" access is an entranceway into your bloodstream that lies completely beneath the skin. An access that is created by joining an artery directly to a vein is called a fistula, while an access made with an artificial tube implanted between the artery and vein is commonly referred to as a "graft". Both types of access are almost always placed into one of the arms, and make it possible for blood to be processed during dialysis.

Dialysis, also called hemodialysis, is a life saving treatment for kidney failure. A dialysis machine is an artificial kidney designed to remove impurities and excess fluid from your blood. During dialysis, a technician uses the AV access to remove some of the blood from the body and circulate it through the dialysis machine. The purified blood is then returned through the dialysis access.

What types of problems can occur with an AV access?

An AV access allows blood to be removed and returned quickly, efficiently, and safely during dialysis, but problems can occur. Abnormal tissue called intimal hyperplasia can build up inside the access or in the veins leading back to the heart. Depending upon the location of the buildup, obstruction from the tissue can cause the pressure in the access to be too high or blood flow to be too slow. If the blockage becomes severe, it can cause the access to clot off completely.

Other less common types of problems include infection, bleeding under the skin and a type of enlargement of the access called an aneurysm.

How are access problems treated?

An AV access is literally a lifeline for a patient on dialysis. If an access is functioning poorly or happens to clot off, dialysis may become ineffective or even delayed. It could take weeks or months before a new access can be placed and made ready somewhere else in the arms or legs. Moreover, vascular "real estate" in the body is limited and can quickly become scarce when multiple accesses fail. A dialysis catheter can be placed into a large vein in the neck, but the complication rate from catheters is much higher than with a fistula or graft. Therefore, every reasonable effort is made to salvage or extent the life of an AV access before it has to be abandoned.

How are AV access problems treated?

When a blood flow or blood pressure problem in an access is discovered, the patient is referred to an interventional radiologist (IR), a doctor specializing in the minimally invasive treatment of fistulas and grafts. The IR uses a combination of physical exam, ultrasound and injection of contrast material under x-ray to diagnose the problem. The IR then uses a special balloon catheter to stretch open the inside of the vein in the area of the blockage, a procedure called an "angioplasty". The procedure is performed with IV sedation or pain medication, and a local anesthetic is used.

Blockages can occur again later at the site of a previous angioplasty or can develop in a new location, so some fistulas and grafts have to be treated multiple times to keep them functioning. A hollow metal tube called a stent can be inserted to open a blocked vein, but stents are expensive and prone to developing an inner lining of intimal hyperplasia that can lead to a recurrent blockage, so stents are only used when angioplasty fails.

When an AV access has clotted off completely, the IR must first inject a "clot busting" drug into the vein to dissolve the clot, then diagnose and treat the underlying blockage. A clotted access is more difficult to treat and has a shorter life span than an access that has not yet clotted. Therefore, every effort is made to detect and treat the problem before it leads to a clot. Unfortunately, warning signs of an underlying problem can be very subtle or arise suddenly, so that a clot can occur even under the most attentive care.


Refer to these websites for more information:

The National Kidney Foundation is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease. www.kidney.org


Central venous angioplasty


Declot


Femoral loop graft


Left arm fistulagram

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Do you know the signs & symptoms?

Deep Vein Thrombosis

Deep Vein Thrombosis (DVT) occurs when a blood clot forms in one of the deep veins of your body, usually in your legs, but sometimes in your arm.

  • Swelling, usually in one leg
    (or arm)
  • Leg pain or tenderness often described as a cramp or
    Charley horse
  • Reddish or bluish skin discoloration
  • Leg (or arm) warm to touch

Pulmonary Embolism

Clots can break off from a DVT and travel to the lung, causing a pulmonary embolism (PE), which can be fatal.

  • Sudden shortness of breath
  • Chest pain-sharp, stabbing; may get worse with deep breath
  • Rapid heart rate
  • Unexplained cough, sometimes with bloody mucus