Dialysis, also called hemodialysis, is the most common treatment for kidney failure. It involves removing blood from the patients body through a large needle or tube, cleaning it of toxins in a dialysis machine, and returning it back to the patient through a second needle or tube. Peritoneal dialysis is a second way of cleaning impurities out of the body using a tube in a patient’s abdomen that introduces large amounts of special fluid to help dissolve the impurities. After several hours, all the fluid is drawn out. Most vascular surgeons are called on to help with the creation of hemodialysis accesses. These can be either temporary or permanent. The temporary ones are used in urgent situations or while waiting for a permanent access to become ready.Most permanent accesses are placed in a patients arm, though occasionally it is placed in someone’s thigh.

Creating a permanent access is a surgical procedure that can be usually done as an outpatient and usually only requires local anaesthesia with some sedation. There are two types of these:

Fistula: where the surgeon connects a vein and an artery directly

Graft: where the surgeon inserts a plastic tube under the skin that connects to an artery on one side and to a vein on the other side.

Each of these types of permanent accesses have advantages and disadvantages. Generally, a fistula takes time to mature, often requiring up to 4 months before it is ready to use. A graft can be used in one to two weeks. However, a fistula can generally last longer and has a lower infection rate than a graft. Both types can be associated with bleeding at dialysis, decreased blood flow to the hand or leg, and nerve injury.

Vascular Testing

Ultrasound
Angiograpy
Echocardiograpy
Elective screening

Disease States

Stroke