Dialysis Access

What is Dialysis Access?

Dialysis access refers to the point where blood is drawn from the body for hemodialysis treatment and then returned. For patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD), reliable vascular access is essential — it is literally their lifeline. Hemodialysis performs the critical job of filtering toxic waste products from the blood, maintaining fluid balance, and regulating electrolytes when the kidneys can no longer perform these functions.

Approximately 550,000 Americans currently receive hemodialysis [1], with most requiring treatment three times per week. Each session requires a dependable access point that can handle the high blood flow rates needed for effective dialysis. At Preferred Vascular Group, we specialize in creating, maintaining, and managing vascular access to ensure our patients receive the reliable dialysis they need.

Types of Dialysis Access

There are three primary types of vascular access used for hemodialysis, each with distinct advantages:

Arteriovenous Fistula (AV Fistula)

An AV fistula is considered the gold standard for dialysis access [2]. It is created surgically by directly connecting an artery to a vein, typically in the forearm or upper arm. This connection allows arterial blood to flow into the vein, causing it to enlarge and strengthen over time — a process called maturation.

Advantages of AV fistulas:

• Longest-lasting type of access (can function for years or even decades)
• Lowest rate of infection compared to other access types
• Lowest rate of clotting (thrombosis)
• Fewest hospitalizations and interventions
• Best long-term outcomes for dialysis patients
• Created using your own blood vessels (no synthetic materials)

AV fistulas typically require 6-12 weeks to mature before they can be used for dialysis, so early planning is essential.

Arteriovenous Graft (AV Graft)

An AV graft uses a synthetic tube, usually made of polytetrafluoroethylene (PTFE), to connect an artery to a vein. Grafts are an option when a patient’s veins are not suitable for creating a fistula.

Characteristics of AV grafts:

• Can be used sooner than fistulas (typically within 2-3 weeks)
• Higher rates of clotting and infection compared to fistulas
• May require more frequent interventions to maintain function
• Average lifespan is shorter than fistulas

Central Venous Catheter

A catheter is a flexible tube inserted into a large vein, usually in the neck, chest, or groin. Catheters are typically used as temporary access while a fistula or graft matures, or in emergency situations when dialysis is needed immediately.

Important considerations:

• Highest risk of infection among all access types
• Higher risk of blood clots in the central veins
• Should be used as a temporary solution whenever possible
• Can be placed quickly when urgent dialysis access is needed

Signs Your Dialysis Access Needs Attention

Monitoring your access between treatments is an important part of dialysis care. Contact your care team if you notice:

• Decreased thrill (the buzzing vibration you can feel over a fistula or graft)
• Swelling, redness, or warmth around the access site
• Bleeding that doesn’t stop after dialysis
• Signs of infection: fever, drainage, or increasing pain at the access site
• Difficulty with needle placement during dialysis sessions
• Prolonged bleeding after needle removal
• Changes in the appearance of the access site
• Numbness, tingling, or coldness in the hand below the access

Dialysis Access Management

One of the greatest challenges facing dialysis patients is keeping their vascular access functioning properly. Blood clots, narrowing of the access site (stenosis), and infections are common complications that can disrupt treatment schedules and impact quality of life.

Common Access Problems

• Thrombosis (clotting): Half or more of dialysis patients will experience at least one episode of access clotting. A clotted access cannot be used for dialysis until it is restored.
• Stenosis (narrowing): Scar tissue can form inside the access or in connected veins, reducing blood flow and increasing the risk of clotting.
• Infection: Any type of access can become infected, but catheters carry the highest risk. Infections require prompt treatment to prevent serious complications.
• Steal syndrome: Occasionally, the access diverts too much blood from the hand, causing pain, numbness, or coldness in the fingers.
• Aneurysm formation: Repeated needle insertions can weaken the vessel wall, causing outpouching that may require repair.

Interventional Access Management

Our vascular specialists provide comprehensive, minimally invasive solutions to keep your dialysis access working:

• Thrombectomy: Removal of blood clots from a thrombosed access using catheter-based techniques, restoring function without surgery
• Angioplasty: A balloon catheter is used to open narrowed areas within or near the access site
• Stent placement: In cases of recurrent narrowing, a small mesh tube may be placed to keep the vessel open
• Access revision: When needed, surgical modification of the access to improve function and longevity

These interventions are typically performed on an outpatient basis and can often restore access function the same day, minimizing missed dialysis sessions.

Comprehensive Dialysis Access Care at PVG

At Preferred Vascular Group, we take a proactive approach to dialysis access management. Our comprehensive program includes:

Pre-Dialysis Planning

We work with patients and their nephrologists well before dialysis is needed to plan the best access strategy. Early referral allows time for:

• Vein mapping to identify the best vessels for fistula creation
• Surgical creation of an AV fistula with adequate time for maturation
• Patient education about access care and protection

Ongoing Monitoring

Regular monitoring helps detect problems before they lead to access failure:

• Surveillance of access flow rates
• Physical examination of the access at each visit
• Prompt evaluation of any changes in access function

Collaborative Care

Our physicians work closely with nephrologists, dialysis centers, and primary care providers to ensure coordinated, comprehensive care. This collaborative approach helps patients proactively manage their access needs and avoid unnecessary hospitalizations.

Why Choose Preferred Vascular Group?

Our vascular specialists have extensive experience in all aspects of dialysis access care. Patients choose PVG because we offer:

• Expert surgical creation of AV fistulas and grafts
• Rapid response to access emergencies, including same-day thrombectomy when possible
• Minimally invasive interventions that restore access function with minimal downtime
• A collaborative care model that integrates seamlessly with your nephrology team
• Eight convenient locations across Georgia and Ohio, providing accessible care close to home

If you are approaching the need for dialysis or experiencing problems with your current access, our specialists can help ensure you have reliable, long-lasting vascular access for your treatments.

References

1. United States Renal Data System. “USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States.” National Institutes of Health, 2023. USRDS
2. Lok CE, et al. “KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update.” American Journal of Kidney Diseases, 2020. PubMed
3. Dialysis Fistula. StatPearls, StatPearls Publishing, 2024. NCBI Bookshelf