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Vascular Access for Hemodialysis

Hemodialysis, also known as dialysis, uses a machine to filter your blood and remove excess fluid. It’s for people with chronic kidney failure whose bodies can no longer perform these tasks. Virginia Mason Franciscan Health provides vascular access services that help you get more out of each dialysis session.

Overview of vascular access for hemodialysis

During dialysis, blood flows from your body through small tubes into a machine (dialyzer). The dialyzer filters out toxins and excess fluids before returning blood to the body. It’s an ongoing treatment you’ll need a few times a week for life or until you receive a kidney transplant.

Vascular access is a minor surgical procedure that enables a large volume of blood to flow from your body into the dialyzer. We perform two types:

  1. Arteriovenous (AV) fistula: Surgeons connect an artery and vein, typically in the arm.
  2. AV graft: We use a human-made device with a rubber-like substance (graft) to join an artery and vein in your arm.

Hemodialysis vascular access in the Puget Sound: Why choose us?

Our highly skilled vascular surgeons have vast experience creating and maintaining dialysis access. They work closely with experts from our Kidney Care program, so you don’t have to worry about the details. 

Highlights of our vascular access services include: 

  • Personalized care: Vascular surgeons recommend the access type that best meets your needs. An AV fistula is most common because it’s long-lasting and has low complication rates. If your blood vessels are not strong enough for a fistula, we discuss the risks and benefits of other options.
  • Ongoing treatment: Vascular access often requires follow-up care to prevent and treat complications, like vessel narrowing, blood clots and infections. Our team delivers the services that keep your dialysis treatments on track. Sometimes, a procedure is necessary to remove a clot or change the venous access type or location.
  • Timely services: If you need to start hemodialysis immediately, our team is here for you. Vascular surgeons are available on short notice to create access for patients with urgent needs.

Types of vascular access for hemodialysis

Knowing more about the different types of vascular access can help you make the decision that’s best for your needs. Our doctors review your options and answer your questions. We discuss any changes that are necessary for maintaining access for years to come.

  • An AV fistula involves stitching an artery and vein together. The fistula may be in your wrist, forearm or upper arm. Through a process called maturation, the combined vessels widen and become stronger. Once a fistula achieves maturation, which can take several weeks to months, you can use it for dialysis access. 

    When it’s time for dialysis, your provider inserts a needle through your skin into the vascular access. A healthy fistula should last many years. If there are complications, we may recommend creating a new one in another area of your arm.

  • An AV graft involves connecting a vein and artery using a special plastic tube (graft). This type of dialysis access is typically created in your elbow or armpit. AV grafts do not require maturation, enabling you to use them sooner for dialysis. 

    When it’s time for dialysis, a member of your care team inserts a needle into the graft. A healthy graft should last a few years. However, this vascular access type is more likely than a fistula to cause blood clots or infections that require additional care.

Fistulogram with intervention

You may need this procedure if we suspect narrowing or a blockage in a fistula or graft. During a fistulogram, we use an imaging study with contrast dye to evaluate blood flow. This test helps us pinpoint the source of the problem and determine whether you need a separate procedure (intervention) to fix it.

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