Vascular Access

Specialized surgical access for dialysis in patients with kidney failure

Life-Sustaining Surgery

Dialysis Access Surgery

Expert creation of vascular access for hemodialysis and peritoneal dialysis. Essential for patients with kidney failure requiring ongoing dialysis treatment.

DR LUBOMYR LEMECH

MBBS (Hons), FRACS (Vascular), DDU (Vascular)

Access Types:

AV Fistula (preferred)
AV Graft
Peritoneal dialysis catheter
Temporary vascath access

Understanding Dialysis Access

Patients who have developed kidney failure require dialysis to maintain their health. Dialysis removes the impurities and fluid from the bloodstream that are normally removed by the kidneys.

Dialysis can be administered in the abdominal cavity (peritoneal dialysis) or via the circulation (haemodialysis).

Your renal physician and dialysis nurse will discuss with you the best modality to start dialysis with.

Vascular Access for Dialysis

Peritoneal Dialysis

Tenckhoff Catheter

Peritoneal dialysis is administered via a peritoneal dialysis (Tenckhoff) catheter. This is inserted into the abdominal cavity via a small incision under general anaesthesia.

Fluid is inserted into the peritoneal cavity and is regularly exchanged in order to remove impurities and fluid from the circulation.

Peritoneal Dialysis Catheter

Advantages

Home-based treatment

Greater independence

Preserves residual kidney function

Considerations

Risk of peritonitis

Requires adequate dexterity

Catheter maintenance needed

May affect body image

Hemodialysis Access

There are 3 methods of receiving haemodialysis

Vascath

Via a tube inserted in a large vein in the neck or leg

Immediate use

Emergency access

Infection risk

Temporary solution

AV Fistula

Via a vein connected to an artery – Arteriovenous fistula

Gold standard

Lowest infection risk

Best long-term option

Requires maturation time

AV Graft

Via a plastic tube connected to an artery and a vein

Immediate use

When veins unsuitable

Higher complication rate

May require revision

Important: Vein Protection

If you are planning to commence haemodialysis, it is important that you protect one of your arms, as damage to the veins from blood tests, drips and blood pressure measurement can prevent the vein from being used to create a successful fistula.

AV Fistula: The Preferred Option

Creation and Maturation

While vascaths can be used to urgently commence dialysis, it is preferable to avoid them in the longer term due to the risk of infection, blockage and damage to the large veins where they are inserted.

If your own veins are an adequate size and quality it is preferable to create an AV fistula. Usually these are created at the wrist, but other configurations may be required.

The fistula requires time to enlarge or mature before it can be used for dialysis. Hence it is preferable for your renal physician to refer you for creation of a fistula long before it is required for dialysis, to allow time for maturation to occur.

Other operations may be required to assist with maturation.

Common Locations

Radiocephalic (wrist)

Brachiocephalic (elbow)

Brachiobasilic (upper arm)

Other configurations as needed

Maturation Timeline

6-8 weeks typical maturation

Early referral essential

Regular monitoring required

Assistance procedures may be needed

When AV Grafts Are Needed

If your own veins are not suitable for fistula creation a plastic tube or prosthetic graft can be used to allow access for haemodialysis.

An operation is performed to connect the graft to an artery and vein in the arm or leg.

The graft can be used almost immediately for dialysis but in the longer term grafts tend to have more problems than fistulae.

Expert Vascular Access Surgery

Dr Lemech provides specialized vascular access surgery for dialysis patients. Early planning and expert surgical technique ensure optimal access function and longevity for life-sustaining dialysis treatment.