Vascular and Interventional Radiology Treatments for Dialysis Access

Interventional radiologists offer treatments to help maintain the access points used in dialysis.

Hemodialysis (commonly referred to as dialysis) is a process that filters the blood in patients living with kidney failure. An AV fistula is surgically created by connecting a native vein to a nearby artery. An AV graft is surgically implanted synthetic tubing material that connects a vein and nearby artery. They are typically located in the arm. Both an AV fistulas and grafts provide easy access for dialysis.

Dialysis requires good blood flow through the AV fistula or graft. When there is a problem, interventional radiologists can help diagnosis and treatment. A fistulagram is done initially. This is an endovascular procedure using wires and catheters (thin tubes). If a problem is seen, such as an abnormal stenosis (narrowing) or thrombosis (blood clot), it can typically be treated in the same procedure with balloon angioplasty (opening a narrowing), thrombectomy (blood clot removal) and/or stent (tube) placement to help reopen the AV fistula or graft.

Traditionally, surgeons create arteriovenous fistulas (connections between an artery and a vein) during open surgery. Interventional radiologists offer an innovative method of fistula creation. Using an endovascular approach, they use heat and pressure from inside the blood vessels to connect an artery to a vein in the arm or leg. These fistulas mature over weeks to months and are then ready for dialysis use.