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.