Treatments
Dialysis Access: Creating and Maintaining Your Lifeline
For anyone on hemodialysis, vascular access is the lifeline that makes treatment possible — and keeping it working well is just as important as creating it in the first place. Cardentey Vascular Care specializes in both: building durable dialysis access and maintaining it over time, working closely with your kidney care team so your dialysis runs smoothly.
What is dialysis access?
Dialysis access is the connection on your body that allows blood to be removed, filtered by the dialysis machine, and returned during hemodialysis. Because dialysis requires moving a large volume of blood quickly and repeatedly, it needs a dedicated, durable access point — most often created surgically in the arm. The right access, created and maintained well, is central to effective dialysis and to your quality of life.
What are the types of dialysis access?
There are three main types of dialysis access, and the best one depends on your veins, your overall health, and your individual circumstances.
- Arteriovenous (AV) fistula — created by connecting one of your own arteries to a vein, usually in the arm. A fistula is generally the preferred long-term access because it tends to last longest and has the lowest risk of infection and clotting. It needs time to "mature" — typically a couple of months — before it can be used.
- AV graft — a soft tube that connects an artery to a vein when your own veins aren't suitable for a fistula. A graft can usually be used sooner than a fistula.
- Dialysis catheter — a tube placed in a large vein, generally used as a temporary bridge while a fistula or graft is created and matures, because catheters carry a higher risk of infection.
Modern guidelines emphasize planning the right access for each person rather than applying a single rule to everyone — looking ahead so that today's access fits into a long-term plan for your care.
How is dialysis access created?
Dialysis access is created in a procedure that connects an artery to a vein, allowing the vein to strengthen and enlarge so it can handle dialysis. Planning often begins with a vein-mapping ultrasound to choose the best vessels. As a board-certified vascular surgeon trained in both open surgical and minimally invasive endovascular techniques, Dr. Cardentey can create access using the approach best suited to your anatomy, including newer minimally invasive options for selected patients.
Why does dialysis access need maintenance?
Dialysis access needs ongoing attention because, over time, the access vein can narrow or develop clots that reduce blood flow and interfere with dialysis. This is one of the most common challenges for people on dialysis, and catching problems early keeps treatment on track. Warning signs your dialysis team watches for include changes in the access's pulse or "thrill," prolonged bleeding after dialysis, swelling of the arm, or difficulty achieving good flow during sessions.
When a problem develops, minimally invasive treatments can usually restore function and preserve the access:
- Angioplasty to reopen a narrowed segment of the access.
- Declotting (thrombectomy) to remove a clot and get a blocked access working again.
- Revision procedures when the access needs surgical adjustment to keep functioning.
Keeping an access working — rather than starting over with a new one — protects your veins and your dialysis schedule. This is why a vascular surgeon involved in both creation and maintenance is so valuable.
How does this work with my kidney doctor and dialysis center?
It works as a partnership. Your nephrologist manages your kidney care, your dialysis center delivers your treatments, and your vascular surgeon creates and maintains the access that makes dialysis possible. We coordinate closely with your kidney care team so that access planning, creation, and any needed maintenance fit seamlessly into your overall treatment.
FAQ
Frequently asked questions
For most people, an AV fistula is the preferred long-term access because it lasts longest and has the lowest risk of infection and clotting. However, the best choice depends on your veins and health — a graft may be better if your veins aren’t suitable, and a catheter may be used temporarily. A vein-mapping ultrasound helps determine the right option for you.
A new AV fistula typically needs a couple of months to mature — to strengthen and enlarge enough for reliable dialysis — before it’s used. AV grafts can usually be used sooner. Your vascular surgeon and dialysis team will confirm when your access is ready.
Access problems are common and usually treatable. A narrowed access can often be reopened with a minimally invasive angioplasty, and a clotted access can frequently be cleared with a declotting procedure — preserving the access rather than creating a new one. Prompt attention to warning signs keeps your dialysis on schedule.
In selected patients with suitable vessel anatomy, a fistula can be created using newer minimally invasive endovascular techniques rather than open surgery. Whether this is an option depends on your individual anatomy, which an evaluation can determine.
Reliable access, expertly maintained
Whether you need a new dialysis access created or you're having trouble with an existing one, the goal is the same: access that works reliably so your dialysis goes smoothly. We're here to create it and to keep it working.
Call our Largo office to schedule an evaluation, or request an appointment online.