Diseases

Vascular Access

Vascular access for dialysis requires expert assessment and meticulous procedure. The surgeon must be equipped with all the varieties of access that can be utilised in a patient and which access will prove to be more beneficial.

Hemodialysis/dialysis is done when kidneys fail to function properly. A dialysis machine is an artificial/mechanical kidney that is used to filter out blood. In this, blood of the patient is made to pass through that dialysis machine, circulated in it and then returned back to the patient. Two needles are inserted into the patient’s bloodstream to carry out the procedure. It is required to be done at least three times per week. The aim of vascular access is to provide proper sites in order to draw out the blood. Arteriovenous fistula, arteriovenous graft, and venous catheter are three types of vascular accesses. The vascular accesses are usually created in the arm and sometimes in legs.

We carry out these procedures in the most sophisticated manner and deliver the best vascular repair in our city.

Arteriovenous Fistula

A surgeon creates a connection between an artery and a vein that is called asArteriovenous Fistula . The vein then undergoes enlargement and thickening and this process is called as maturation. A mature fistula makes repeated puncturing easy. It usually takes three to six months or can take up to a year in rare cases. Patients should undergo evaluation for arteriovenous fistula creation at least a year before the dialysis.

It is a preferred vascular access to lower rate of infection and clot formation, resulting in better success than other types of vascular access. But in some patients like olds and ones with small veins, this procedure cannot be performed.

We are specialized  for providing unmatchable AV fistula associated services and best vascular repair in Hyderabad.

Arteriovenous Graft

Patients who cannot go for arteriovenous fistula, an arteriovenous graft is considered for them. It is a piece of teflon or fabric made of artificial tubing which is attached on an artery at one end, and vein on the other end. The tube is placed entirely under the skin and is punctured during dialysis. It is used two to three weeks after the operation. However, infection and clotting is more with arteriovenous grafts than fistulas.

Venous Catheter

Venous catheter, a plastic tube, is inserted into a large vein. The outer portion of the catheter is exposed to the chest wall and allows the tubing for the dialysis machine connection. It is infection prone as the catheter is not entirely under the skin. Venous catheters may get clogged and lack efficiency in dialysis.

Venous catheters are mostly temporary vascular accesses, and are placed only when there is urgency to perform dialysis. Rarely, a venous catheter may be used for long-term vascular access when other options are unavailable.

In preparation for vascular access, the patient should keep one arm reserved from where there should be no blood draws, intravenous lines (IVs) or taking of blood pressure. The vascular surgeon can prescribe a non-invasive  duplex ultrasound, or a venogram. A venogram, special x-ray procedure. In this a contrast dye is injected into the veins, therefore, the  detailed picture of the veins is taken. It is only required in patients having a lot of previous dialysis access procedures or venous anatomy is unclear. The vascular surgeon with his staff will advise the patient procedure prerequisites and medications.

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Most vascular access procedures are done on an outpatient basis, under local anesthesia. The anesthesiologist administers certain sedative medication to allow the patient to stay relaxed and drowsy. Mostly General anesthesia is not used.

Patients should keep the incision covered and dry for at least two days, postoperatively. The incision should be avoided from soaking or scrubbing until the complete healing. The arm in which the incision was made, should be elevated with the help of a few pillows during sitting or sleeping. This will help minimize the swelling. A mild swelling and pain at the site of incision is acceptable postoperatively. The surgeon should be contacted as soon as possible if the symptoms become severe.

Patients might experience coolness, tingling or numbness in the fingertips of the arm where the access is created. It is very normal and improves or resolves with time. If these symptoms worsen, such a situation is called  “steal”. In such a situation, contact your physician as soon as possible. This usually happens when the access which is created “steals’ ‘ the  blood away from the hand. This problem can be cured using certain procedures which restores the normal condition.

We work to deliver the best vascular repair in Hyderabad and help you to reinstate  your vascular health in every possible way.

Complications which can occur due to contamination and bleeding. The health care professional must be contacted as quickly as feasible for any fever over 100 degree Farenheit, drainage from the incision or lively bleeding. Steal, as defined above, is an unusual hardship.

Arteriovenous fistulas in non-maturation are potential complications. In different words, the vein never enlarges or turns into thick-walled sufficient for use for dialysis. In a few cases, reasons for non-maturation may be recognized and corrected, permitting maturation to arise.

After a fistula or graft has been in location for a length of time, it could turn out to be abnormally large, or expand an aneurysm. There are strategies that may be accomplished to accurately aneurysmal fistulas.

Arteriovenous fistulas and grafts can expand slender areas (stenoses) which may also lower the performance of dialysis or occurrence of complications like growing a clot. Stenosis may be handled with an operation, or with a minimally invasive/endovascular approach. (link to minimally invasive and endovascular treatment options here.) After the access has evolved a clot, it could or might not be capable of being salvaged.

The arm in which access is created should no longer be slept on or used to hold heavy items. The arm should no longer be used for blood withdrawal or blood pressure measurements and injections. Clothing or add-ons worn at the arm ought to be unfastened and non-constricting. The location over the access should be kept clean.

In the functioning access vibration should be felt which is referred to as a “thrill.” The medical doctor or dialysis group of workers can display to the patient how the thrill is felt. If the affected person notices that the vibrations have disappeared, he/she ought to consult a medical doctor as quickly as possible.

So, seek the most sophisticated vascular services and the best vascular repair in city at Vascular Center.

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