Hemodialysis Access

(Chronic kidney/renal disease)

Over 660,000 Americans have end stage kidney disease (ESRD). The most common causes of kidney disease are high blood pressure and diabetes. When your kidneys fail, your body is unable to remove chemical toxins and excess water from your body. The treatment for kidney failure is dialysis or kidney transplantation which can take years to receive.

Hemodialysis (HD) takes the place of your kidneys by removing wastes and extra chemicals from your body and restoring normal pH balance. Some patients may be candidates for peritoneal dialysis but HD is often more common. Catheters underneath the skin (Permacath/Vascath) can be used as a short term access for HD, but it is not preferable for most patients. These catheters must be kept clean and dry which can complicate hygiene routines such as showering.

To create a more long-term HD access for you, a vascular surgeon needs to perform a surgical procedure. This procedure connects an artery and a vein of the arm with the intent of making the vein big enough for the dialysis catheters to perform HD. This surgically connected artery and vein is called an “AV fistula.” Sometimes, surgeons use a prosthetic graft instead of a fistula which is called an “AV graft.” This fistula or graft then becomes the access site for HD.

Unfortunately, these AV fistulas and grafts can become clogged or narrowed over time making HD difficult or impossible. Just like a car, AV fistulas and grafts require routine maintenance to ensure long-term usage.

Washington Hospital offers another option for patients with dialysis access problems called the HeRO graft device. The HeRO Graft (Hemodialysis Reliable Outflow) is a fully subcutaneous AV access solution clinically proven to maintain long-term access for hemodialysis patients with central venous stenosis. Our surgeons have inserted more HeRO graft devices than any other local hospital.

If you have been newly diagnosed with ESRD or have been on dialysis using a catheter, speak to your primary doctor or Nephrologist about a referral to one of our Vascular Surgeons to discuss your surgical HD access options.