Texan Vein & Vascular we want to ensure our patients undergoing hemodialysis are getting the
best treatment plan possible. Hemodialysis requires access to the blood
flowing inside the blood vessels so it can be withdrawn and cleansed.
Repeated needle puncture is very hard on veins and arteries, however.
Special surgical techniques must be used to create an area that can be
used for repeated blood access and as a
double-board certified vascular surgeon,
Dr. Vinit Varu has the expertise to ensure you have the right option chosen for you.
He will work intimately with your Kidney specialist to make sure your
dialysis needs are taken care of. Treatment options include:
While still in the hospital, many people undergo hemodialysis using a catheter
placed into a large vein in the neck region. Since the catheter is placed
directly into the circulatory system, it may provide a route for infection
and is not a long- term solution. Central Venous Catheters (CVCs) in place
longer than two to three months may lead to complications such as vein
narrowing or clotting. Long-term hemodialysis patients will need other,
One method is the creation of an arteriovenous fistula. In this technique
an artery and a vein are sewn together. Arteries carry blood at high pressure
away from the heart into every part of the body. Veins collect blood and
carry it at low pressure back to the heart. Attaching the artery to the
vein causes the vein to balloon out as high-pressure blood flows directly
into it from the artery. About six weeks after operation, the vein grows
tougher and thicker. This fact, along with the increased size, make the
vein ideal to use for hemodialysis access.
When the AV graft is implanted, two small incisions are made (AV grafts
are commonly placed in the forearm, but they can also be placed in the
upper arm or the thigh if necessary). A tunnel is made under the skin
to aid in the placement of the graft. One end of the graft is sewn to
the artery and the other to the vein. Blood will then flow rapidly from
the artery through the graft into the vein. Historically, grafts would
require 4 weeks until able to be accessed, but recently the technology
has evolved to allow dialysis the same day the grafts are implanted, supplanting
the use of catheters.
What to Expect
You will experience some bruising, swelling and discomfort in your arm.
This is normal and pain medication may be prescribed. Your doctor will
give you specific advice, but in general these steps should be followed
after you are released from the hospital:
- Keep the arm extended and elevated above the level of the heart; place
it on a pillow while lying down and hold it up while sitting.
- Avoid putting any pressure on the arm or swinging it around.
- Rest, follow your diet, and take your prescription medicines.
- Perform specific exercises, such as squeezing a ball to help the vein grow
- When the graft is new there may be bleeding into the tissue surrounding
the graft after the needle is removed. The chance of this occurring will
diminish as your body heals around and into the graft.
- Do not compress the graft or fistula with tight clothing, bracelets or
watches because blood flow might be stopped. Similarly, do not rest a
heavy load against it, like a bag of groceries, or sleep on it. And do
not have your blood pressure taken in the arm with the graft or fistula
because the pressure cuff may stop blood flow.
How Long Do Grafts Stay Open?
On average, grafts stay open about a year. It is difficult to predict because
some grafts become blocked after only a few months while others may stay
open for years. You will know when the graft is blocked because the swishing
noise and vibration (bruit and thrill) stop. Blockage usually occurs because
scar tissue forms where the graft is connected to the vein. This slows
the blood flow and produces a clot. When this happens, it is not dangerous,
but it does require another trip to the Cath lab where the scar tissue
and clot are removed and the graft is repaired.