What Is Dialysis Access and Why Does It Matter?
For patients with end-stage renal disease (ESRD) undergoing hemodialysis, a well-functioning vascular access is absolutely vital. Dialysis cannot happen without reliable blood flow and delays or access failures can be life-threatening.
There are two main types of long-term dialysis access:
- Arteriovenous (AV) Fistula: A surgical connection between an artery and a vein, usually in the arm. This causes the vein to enlarge and thicken so it can withstand repeated needle access for dialysis.
- AV Graft: A soft synthetic tube implanted under the skin to connect an artery to a vein when a patient’s own veins are not suitable for a fistula.
At Vascular Clinic, we specialize in creating and maintaining dialysis accesses with expert surgical precision and rapid outpatient intervention to minimize disruptions to your dialysis schedule.
How We Create Dialysis Access at Vascular Clinic
Surgical Creation of AV Fistulas and AV Grafts
AV Fistula (Preferred First Option):
- Created during a short outpatient surgery
- Performed under local anesthesia with mild sedation
- A small incision connects a native artery to a vein, typically at the wrist or elbow
- The fistula matures over 4–8 weeks, becoming stronger for reliable dialysis use
- We provide clear guidance on exercises to help the fistula develop, like squeezing a soft ball
AV Graft:
- Used when veins are too small or unsuitable for a fistula
- A soft, flexible graft is tunneled under the skin to link an artery and vein
- Can often be used within 4 weeks
- Ideal when access is needed urgently or if fistulas have failed
All procedures are coordinated closely with your nephrologist and dialysis center to ensure access is ready when needed and avoids delays or catheter use.
Tunneled dialysis catheters placement, exchange or removal
For patients who need immediate dialysis or are waiting for fistula/graft maturation, we offer:
- Placement of long-term tunneled dialysis catheters via the neck or chest
- Routine catheter exchanges to maintain safe and functional access
- Timely removal of catheters once a mature fistula or graft becomes available
All catheter procedures are performed under local anesthesia and light sedation in a sterile environment, with ultrasound and fluoroscopic guidance for accuracy and comfort.
How We Maintain Dialysis Access
Fast, Minimally Invasive Access Interventions
Once your fistula or graft is in use, it may develop issues over time—narrowings, clots, or flow problems. At Vascular Clinic, we offer same-day or next-day access maintenance, often avoiding hospitalization or catheter placement.
Common Problems We Treat:
- Stenosis (narrowing) – leads to high pressures or poor dialysis flow
- Thrombosis (clot) – sudden loss of function in fistula/graft
- Difficulty cannulating – hard to access the site for dialysis
- Central vein stenosis – narrowed veins deeper in the chest affecting outflow
Steal syndrome – hand pain or coldness due to too much blood being diverted from the hand
Treatments We Perform:
- Fistulogram (access angiogram) to assess blood flow
- Balloon angioplasty to stretch narrowed areas
- Stent placement if needed for recurrent narrowing
- Thrombectomy/thrombolysis to remove clots and restore function
- Banding or revision for steal syndrome or high-output fistulas
- Planned surgical revisions for aneurysms or aging grafts
All procedures are done with local anesthesia and light sedation, typically in under 1–2 hours, and you can often go straight to dialysis afterward with a restored access—no catheter needed.
What to Expect After Access Procedures
- Most interventions are outpatient
- Minimal discomfort with numbing medication and sedation
- Our nurses and techs keep you comfortable and informed
- You’ll receive clear instructions on arm care and signs to watch for
- We coordinate closely with your dialysis unit and nephrologist, sending detailed reports of the procedure
Preventive Access Management
We don’t just wait for problems to occur. If your dialysis unit notes:
- High venous pressures
- Prolonged bleeding after dialysis
- Declining flow rates
We intervene before the access clots, helping avoid urgent situations. Regular surveillance improves long-term outcomes.
Frequently Asked Questions
How soon can I dialyze after an access procedure?
Often the same day—we aim to restore function quickly to avoid missed sessions or temporary catheter placement.
What’s the difference between a fistula and a graft?
A fistula uses your own vein, is more durable, and has fewer infections. A graft is synthetic, used when veins are unsuitable, and can be used sooner after placement.
What if my fistula has clotted?
Call us immediately—we treat clotted accesses as urgent priorities and can often reopen them within hours.
Can access problems be prevented?
Yes. By monitoring pressures and blood flow trends from your dialysis center and acting early, we often prevent full blockages.
Why Choose Vascular Clinic?
- Board-Certified Vascular Surgeons and Interventionalists
- On-site imaging and access procedures with rapid turnaround
- Same-day service for access emergencies
- Experienced in both surgical creation and complex access revision
- Collaborative coordination with your nephrology and dialysis team
- Respectful, patient-centered care with long-term relationships
We don’t just treat your access—we care for your lifeline with the urgency, precision, and compassion it deserves.
