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AV ACCESS

Services //

CONSULTATION, NON-INVASIVE EVALUATION 

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  • Comprehensive outpatient consultation services

  • Evaluation of suitability for Peritoneal dialysis or hemodialysis

  • Evaluation for percutaneous AV fistula (endoAVF) creation

  • Referral service for AV access creation by vascular surgery 

  • Immediate coordination of care with referring providers and dialysis centers

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  • Non-invasive ultrasound evaluation for:

    • creation of endoAVF or surgical AV access

    • AV access maturation and beginning hemodialysis

    • follow-up and/or diagnosis of AV access function / problems

    • suitability for percutaneous peritoneal dialysis (PD) catheter placement 

    • suitable veins for tunneled dialysis catheter placement

INVASIVE EVALUATION OF FAILING/FAILED AV ACCESS 
 

  • Arteriography, venography and IVUS (intravascular ultrasound)

  • Duplex doppler imaging and spectral analysis of blood flow, as needed

  • Arteriographic evaluation of hand ischemia associated with AV access

  • Vein mapping prior to creation of subsequent AV access

COMPREHENSIVE AV ACCESS CARE 
 
We provide an extensive range of advanced therapeutic procedures to restore serviceable function to your AV access. Some of these may include:

  • high pressure angioplasty (balloon dilatation) of stenoses (vessel narrowing) and occlusions

  • stenting of persistent or recurrent stenoses

  • drug-coated balloon angioplasty to suppress abnormal tissue growth in vessels

  • cutting balloon angioplasty in stenoses resistant to conventional angioplasty

  • stent grafting of severe vessel narrowing or occlusions

  • AV access declotting with thrombolytics and mechanical devices to remove blood clots that prevent your AV access from functioning

  • IVUS (intravascular ultrasound) to more accurately define the nature and extent of the vessel abnormality, to determine the proper size of angioplasty balloon or stent required for satisfactory repair and to confirm the success of the vessel repair.

 
Occasionally, An AV graft or fistula turns out to be end-stage (unusable). Regular dialysis is still required. In that case, we will insert a tunneled hemodialysis catheter whose tip reaches the heart so that dialysis will not be interrupted in the interim until the newly created permanent AV access is usable. 
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15 to 40% of new surgically-created AV fistulas are not usable at first and require additional time and attention to help them mature to potential usability. We have extensive experience employing minimally-invasive endovascular techniques to diagnose and correct the underlying causes of delayed maturation. These problems due to stenosis in AV access tend to recur. All our patients are regularly followed to detect such problems and to preemptively address them before they cause AV access failure.

CONTRAST ALLERGY AND CO2 ANGIOGRAPHY
 
Some patients are highly allergic to x-ray contrast (dye) and may have experienced life-threatening or severe reactions in the past. In addition, patients who have received a kidney transplant and still have a patent but dysfunctional AV access can be safely studied and treated using CO2 gas instead of the usual x-ray dye.  
SWOLLEN ARM
 
Often, patients are referred to us for prolonged bleeding after their dialysis needles are removed (decannulation). This usually results from vein narrowing (stenosis) somewhere between the AV access and the veins in the chest. Some patients may even have a severely swollen arm because of a stenosis in a vein near or in the chest that prevents blood from the AV access to freely return to the heart. We have extensive experience in treating these problems with angioplasty balloons and sometimes, with stents. These problems tend to recur and require systematic follow-up and repeated treatment.

CATASTROPHIC HEMORRHAGE

Patients with enlarging and fragile aneurysms at sites of repeated cannulation (often associated with stenosis (vein narrowing) near the neck or in chest are at risk for rupture of the aneurysm and catastrophic hemorrhage, rapidly causing death. We have deep experience in treating these underlying stenoses responsible for pressurizing the aneurysms. We may also need to stabilize oozing or ruptured aneurysms (or controlling them by mechanical means) until the patient can be urgently transferred to a nearby hospital for vascular surgery.
 

CENTRAL AND PERIPHERAL CATHETERS

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We provide a complete range of central, implanted and peripheral catheter services, including:

  • placement, revision, replacement and removal, using ultrasound and fluorosopic guidance to minimize the risk of complications.

  • Typical catheters include, temporary and tunneled dialysis catheters, Hickman catheters, implantable ports for chemotherapy, fluid and drug administration, PICCS.

PERITONEAL DIALYSIS CATHETERS

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We offer percutaneous placement and care of peritoneal dialysis (PD) catheters to selected patients who have been approved for home PD.

  • PD catheter placement typically takes less than 1 hour using local anesthesia and mild i.v. sedation. The PD catheter is generally ready for use within 2 weeks but can be used earlier, if necessary.

  • In suitable patients who are autonomous and/or who work or travel, PD is a welcome alternative to the constraints of hemodialysis.

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