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Dialysis & Access Intervention

Dialysis and Access Interventions are minimally invasive procedures performed to improve blood flow in the fistula and grafts placed in the blood vessels of dialysis patients. Dialysis is a process used to treat patients whose kidneys are not working properly. It involves a special machine and tubing that removes blood from the body, cleanses it of waste and extra fluid and then returns it back to the body.

Your doctor may recommend a Dialysis and Access Intervention to treat:

  • Narrowing of dialysis fistula or grafts. When there is decreased flow in a graft or fistula, angioplasty or angioplasty with vascular stenting may be performed.
  • Thrombosis of dialysis fistulas or grafts. When blood does not flow smoothly, it can begin to coagulate, turning from a free-flowing liquid to a semi-solid gel, called a blood clot or thrombus. When blood clots in a fistula or graft prevent dialysis from being performed, catheter-directed thrombolysis with clot-dissolving drugs may be performed.

Prior to your procedure, your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally. You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule. You will be given a gown to wear during the procedure.

In these procedures, X-ray imaging equipment, a balloon catheter, catheter, guide wire, sheath, stent and a medical device that dissolves blood clots may be used:

  • A balloon catheter - is a long, thin plastic tube with a tiny balloon at its tip.
  • A stent - is a small, wire mesh tube. Balloons and stents come in varying sizes to match the size of the diseased blood vessel.
  • A catheter - is a long, thin, hollow plastic tube, about as thick as a strand of spaghetti. These catheters are designed so that blood dissolving medications can be delivered successfully within the blood clot.

There also are medical devices that can be used to dissolve the clots mechanically. Your interventional radiologist will decide which technique is most appropriate for you.

  • A guide wire - is a thin wire used to guide the placement of the diagnostic catheter, angioplasty balloon catheter and the vascular stent.
  • A sheath - is a vascular tube placed into the fistula or graft and that allows easy catheter exchanges during these procedures.

Stents are specially designed metal mesh tubes that are collapsed when they are inserted into the body and then expanded inside the vessel to prop the walls open. In some cases the stent may have an artificial fabric covering. Other equipment that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat and blood pressure.

Angioplasty and vascular stenting: Using imaging guidance, an inflatable balloon mounted at the tip of a catheter is inserted through the skin into the fistula or graft and advanced to the blockage. There, the balloon is inflated and deflated. In this process, the balloon expands the vein or artery wall, increasing blood flow through the fistula or graft. A stent may be placed to hold the vessel open.

Catheter-directed thrombolysis: Using X-ray guidance and a contrast material that helps show the blood vessel, your interventional radiologist will insert a catheter through the skin into a vessel (artery or vein) and direct it to the thrombosis, or blockage.

The blood clot will then be dissolved in one of two ways:

  • By delivering medication directly to the blood clot
  • By positioning a mechanical device at the site to break up the clot

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