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Dialysis Access Management

At Montgomery Vascular Care, we offer the full scope of care for end-stage renal disease (ESRD). ESRD occurs when the kidneys are no longer able to function. Patients with ESRD need dialysis, an artificial process for removing waste products and excess fluids from the body that are normally eliminated by the kidneys. Kidney failure is the most common cause for dialysis. ESRD patients have typically one of three different types of hemodialysis access: arteriovenous fistula, arteriovenous graft, or a catheter . A fistula is the preferred type of access.

Incidence of ESRD is highest in people over the age of 75.

What We Offer…

Vein Mapping

Vein mapping is an x-ray test used to determine the diameter, length, and suitability of the superficial veins for placement of a dialysis access. It is performed by injecting contrast into the veins or by use of ultrasound.

X-ray image of a potential dialysis access.

Angioplasty, Stenting, and Fistula Salvage

Many poorly functioning accesses suffer from stenosis, which is a blockage or narrowing in the access. To open a stenosis, we may intervene with angioplasty and/or stent placement to improve blood flow. In angioplasty, a small balloon, mounted on a catheter, is inflated within the blood vessel, expanding the narrowed access. If necessary, we may also insert a metal stent to maintain even blood flow throughout the access. For arteriovenous (AV) fistulas that have not "matured" for optimal dialysis treatment, we can provide a series of angioplasty and/or stenting treatments to expand the access. This series of access interventions, performed over the course of a few weeks, is known as fistula salvage.

An inflated balloon sets a stent into its final position.

Thrombectomy and Thrombolysis

For clotted accesses, we offer thrombectomy (or embolectomy), to remove thrombi (blood clots) from the access. Mechanical thrombectomy devices can remove clots from both AV fistulas and grafts, creating a vacuum effect to pull out the clots. Another alternative to remove clots is thrombolysis, which utilizes pharmacological methods to break down or break up these blood clots.

Thrombi removal from a clotted access.

Central Venous Catheter Placement

We offer dialysis catheter placement. The catheter is a flexible hollow tube which is tunneled under the skin from the point of insertion in the vein to an exit site on the chest wall. However, catheters are typically only used up to three weeks because they are prone to clotting, infection, and kinking. A catheter may be placed while a fistula or graft is waiting to mature. Once your AV fistula or graft is functioning properly, we will safely remove your dialysis catheter.

Central venous catheters can be used for dialysis while an AV fistula or graft matures.