Dialysis Access at the UPMC Division of Vascular Surgery

Patients in need of dialysis access can receive high quality care from experts in the UPMC Division of Vascular Surgery.

Contact the UPMC Heart and Vascular Institute

To request an appointment, contact the UPMC Heart and Vascular Institute:

• Call: 1-855-876-2484
• Email: HeartandVascular@upmc.edu

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What Is Dialysis?

Dialysis is a treatment for people with end-stage kidney disease.

If your kidneys can't filter waste from your blood, fluid and toxins can build up in your body. This leads to serious health problems and eventually death.

Types of dialysis

Dialysis is a process that uses a machine to take over for your kidneys.

The two types of dialysis are:

• Hemodialysis — pumps blood out of your body, filters it through a machine, and returns it to your body. This is the most common form of dialysis in the United States.
• Peritoneal dialysis — this option allows cleansing of the blood while resting at night. It occurs through a small tube in the abdominal wall for fluid exchange.

Before you begin dialysis, a surgeon will need to create a way for the machine to access your blood vessels. This will make it possible for your blood to flow in and out of your body during treatment.

Types of Dialysis Access

The experts at the UPMC Division of Vascular Surgery specialize in dialysis access procedures, including:

Arteriovenous (AV) fistula

• A connection between an artery and a vein, often in your arm.
• Usually considered the best option for dialysis access.
• Tends to provide reliable dialysis access with a low risk of infection.
• Can take months to mature and be ready for use after access surgery.
• Many people have an anatomy that can make an AV fistula hard to create.

Arteriovenous (AV) graft

• A connection between an artery and a vein using a tube of man-made material.
• A good option for people with small veins or other anatomic features that make an AV fistula hard to create.
• Can be ready for use in as little as two weeks, or even sooner in some cases.
• Can close more quickly and have a higher risk for infection.

Tunneled dialysis catheter (or venous catheter)

• A soft tube placed in a large vein in your neck, chest, or leg.
• Allows blood to flow in and out of the dialysis machine.
• Can be ready for use right away.
• Has a high risk of blood clots and infection when compared to a fistula or graft.

Before Your Dialysis Access Procedure

Before your procedure, you’ll undergo a thorough physical exam.

You'll talk with your surgeon about what is best for you, including the placement of your fistula, graft, or catheter.

Before an AV fistula or graft procedure

In most cases, surgeons will place the fistula or graft in your non-dominant arm.

Sometimes, they may place it in your dominant arm. In rare cases, they will place it in your thigh.

On the day of your AV fistula or graft procedure, you may receive:

• Local anesthesia that numbs the small incision site, along with medicine to help you relax.
• A regional block that numbs the nerves in your arm or leg, along with medicine to help you relax.
• General anesthesia that puts you to sleep.

Before a tunneled dialysis catheter procedure

Most often, your surgeon will place the tunneled dialysis catheter in your neck or chest. Sometimes, he or she may place it in your leg.

On the day of your procedure, you’ll receive:

• Local anesthesia — medicine that numbs the catheter insertion site.
• Drugs to help you relax.

What to Expect During Your Dialysis Access Procedure

During an AV fistula or graft procedure

Your vascular surgeon will clean your arm or leg with antiseptic solution. Next, he or she will make a small cut between an artery and a vein.

• If you're getting a fistula then your surgeon will directly connect the artery and vein with very fine suture material.
• If you're getting a graft then your surgeon will place the graft between your artery and vein/sew the graft to the artery at one end and the vein at the other using very fine suture material.

After creating the fistula or placing the graft, your surgeon will close your incision with absorbable sutures.

During a tunneled dialysis catheter procedure

During the procedure, your vascular surgeon will:

• Clean the insertion site with antiseptic solution.
• Make a small cut and insert the catheter into your vein.
• Position one end of the catheter near the heart. The other end lies in a tunnel under your skin before emerging outside of your body.
• Place a cap on the end of the catheter outside of your body.

What to Expect After Your Dialysis Access Procedure

Your surgeon will give you instructions before you leave, including:

• How to care for your fistula, graft, or catheter site.
• When you can return to your normal routine.

If you have an AV fistula or graft, your vein slowly will get larger.

You should be able to feel a vibration (thrill) when you place your hand over the fistula or graft site. Your arm or leg may also occasionally feel cool because the procedure redirected some of your blood supply.

You should start hemodialysis using most:

• Fistulae no sooner than 10-12 weeks.
• Grafts no sooner than 2-3 weeks.

Risks of Dialysis Access Procedures

Like all medical procedures, dialysis access procedures can have some risks such as bleeding and infection.

Rarely, people can develop significant lack of blood flow to the extremity with the fistula or graft. This can cause pain and dysfunction in the arm or leg.

Contact your surgeon right away if you have:

• Severe swelling.
• Fevers or pus drainage from your surgical site.
• A surgical dressing that is soaked through.
• Coldness, numbness, or pain in the extremity with the fistula or graft.