Dialysis Program
When kidneys can no longer function normally effectively, dialysis is a form of treatment that works to replace the renal function and keep the body in balance by filtering waste, maintaining appropriate levels of electrolytes. There are two types of dialysis: hemodialysis and peritoneal dialysis. An artificial kidney is used during dialysis to replace the function of the patient’s kidney. This artificial kidney will remove waste, chemicals and fluid from the blood. Dialysis is a life-saving treatment. At the same time it is also life-changing as patients adjust to a new normal, and new daily routines.
The typical threshold for a physician to suggest dialysis is when kidneys lose up to 90 percent of their filtering ability. In some occasions dialysis is needed temporarily. However, most patients with progressive loss of renal function will end up needing dialysis permanently.
Dialysis Access Options
Regardless of the modality of dialysis - hemodialysis or peritoneal dialysis - an access is required to begin their dialysis treatment. Vascular surgeons obtain access in three ways: using a catheter, an arteriovenous graft or an arteriovenous fistula. Arteriovenous is a term that indicates that a connection between an artery and a vein is created, either directly (in case of a fistula) or indirectly (in case of a graft)
When a catheter is used for dialysis access, it is inserted into a large vein located in the neck. Such a catheter is prone to infection and only represent a temporary dialysis option. An arteriovenous graft is used as a conduit to connect a vein to an artery. The graft is formed using a soft, plastic tube, or biologic material. Hemodialysis can be administered once the graft has healed. Grafts require careful attention and care so that problems do not arise.
Perhaps the best and most preferred type of dialysis access is an arteriovenous fistula, which connects directly an artery to a vein. Fistulas have a lower incidence of complications and longer durability than arteriovenous grafts. For this reason, they are the preferred method of hemodialysis.
All forms of dialysis access at some point will require revision to prolong the life of the access. Revisions, angioplasty, stent placement, and sometimes replacement of the fistula is needed.
Determining the appropriate treatment strategy for a patient in need for dialysis involves careful consideration of the patient’s health, anatomy and lifestyle. Our multidisciplinary team of surgeons, interventionalists, nurses and coordinators provide patient-tailored dialysis interventions. We are available to offer patient care 24 hours a day, 7 days a week for patients in need of emergent, short-term or long-term dialysis access.
We provide options for both hemodialysis and peritoneal dialysis through a combination of surgical interventions and sophisticated interventional radiologic procedures. These options include:
- Primary, autogenous arteriovenous fistulas
- Arteriovenous grafts
- Composite grafts and stents
- Revision of malfunctioning, existing access
- Insertion of temporary tunneled catheter
- Peritoneal dialysis catheter
Faculty
Dale Distant, MD: Program Director, Hemodialysis Access Program. Endocrine surgery.
John Tomasula, MD: Hemodialysis Access Program.
To book an appointment
Call: (718) 270-3168