Dialysis Access

Patients with chronic renal failure need regular hemodialysis that performs the kidney’s job of ridding the body of toxic waste products, and to maintain fluid, electrolyte and acid-base balance. One of the greatest challenges facing patients and their doctors is keeping the vascular access graft open for dialysis. Most patients with chronic renal failure receive dialysis using synthetic bridge grafts made of polytetrafluoroethylene (PTFE). These tend to clot or malfunction, decreasing reliable access for life-sustaining dialysis and causing considerable morbidity, discomfort and inconvenience for dialysis patients.

Currently, there are about 250,000 Medicare patients undergoing hemodialysis in the United States, and half or more will have at least one episode of clotting (thrombosis) of the graft. Until recently, most thrombosed grafts had been managed by surgically removing the clot, but vascular interventionalists are increasingly providing nonsurgical dialysis declotting. These interventions are safer, less costly, and equally effective and they improve the quality of life for dialysis patients.

Interventional techniques to break up the clot include:

  • Angioplasty
  • Stenting
  • Combination of drugs and mechanical devices to break up the clot
  • Balloon thrombectomy (clot removal) techniques
  • Use of mechanical thrombectomy devices

The success of the interventional technique is dependent on removing the lesion that caused the blood clot/arterial plug.

Because of the clotting issues with dialysis grafts, a growing number of patients are having an arteriovenous fistula, which is a connection created surgically by joining a vein and an artery in the forearm that allows blood from the artery to flow into the vein, thus providing access for dialysis. Fistulas are considered the “gold standard” for maintaining access to a patient’s circulatory system, to provide life-sustaining dialysis. They last longer, need less rework, and are associated with lower rates of infections, hospitalization and death than other types of access.