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Vascular Access Management

Kidney & Hypertension Specialists has a Vascular Access Center that performs specialized Interventional and Diagnostic procedures to dialysis patients experiencing problems with their dialysis access. While not every dialysis patient is a candidate for outpatient intervention, early surveillance and treatment of problems can greatly reduce major complications and minimize hospitalization related to access care.
An Interventional Procedure may be needed if a Fistula Angiogram study indicates:

  • Difficulty cannulating the access
  • Increased venous pressure during dialysis
  • Excessive negative arterial pressure during dialysis
  • Prolonged bleeding after dialysis
  • Inability to achieve adequate blood flow on dialysis
  • Decrease in thrill and bruit anywhere in the fistula or graft circuit
  • Cold hand, numbness and or pain to the lower arm.
  • Swelling of the upper arm of the access site
  • Swelling of the chest and face with collateral vessels
  • Collapsing fistula
  • No pulse or thrill of the access site

Catheter Placement or Exchange may be performed if there is:

  • Infection of fistula or graft
  • Clotting in the catheter tip
  • Exposed cuff (the cuff that adheres the catheter to surrounding tissue)
  • Damage (puncture or crack in the catheter)
  • Decreased Abnormal Recirculation readings of blood flow during dialysis

Interventional Procedures Performed include:

  • Angiogram / Fistulogram – Contrast dye is injected through the graft or fistula to determine the cause of a blood flow problem. If stenosis or narrowing is found, this procedure may require an angioplasty and/or stent.
  • Angioplasty – A balloon catheter is inserted through the graft or fistula and inflated to dilate or open the narrowing.
  • Declot / Thrombectomy – Special Clot dissolving medication along with balloon angioplasty to re¬establish blood flow.
  • Stent Placement – Placement of an open metallic or encapsulating stent to hold open a blood vessel.
  • Tunneled Dialysis Catheter Insertion – Catheter is placed in one of the veins in the neck, chest or leg. (Central Line, Mediport, PICC lines)
  • Tunneled Catheter Exchange – Replacement of a catheter for a new or different type. This may also involve an angioplasty if the vessel pathway is too narrow for the catheter.
  • Tunneled Dialysis Catheter Removal – Removal of catheter when no longer needed. Temporary Catheter Insertion – This catheter is usually placed in the vein and is utilized for dialysis or special medication administration for a short period of time.
  • Vein Mapping Study – Ultrasound measurements of the veins and arteries along with an angiogram injection used to visualize veins in the arms and chest to help plan the placement of a new graft or fistula.
  • Paracentesis – Drainage of fluid that accumulates in the abdomen.
  • Thoracentesis¬ Drainage of fluid that accumulates in the lungs.