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Dialysis Access Creation, Management and Revision

Renal failure continues to increase in frequency as the population ages. The kidneys are responsible for filtering out toxins from the bloodstream. With uncontrolled high blood pressure and poorly controlled diabetes the kidneys become damaged. If the damage becomes severe patients will require long term dialysis. Successful dialysis requires adequate venous access. In the acute setting this can be done using a dialysis catheter. However, these catheters can cause venous stenosis. Ideally, prior to needing dialysis, a fistula or dialysis shunt would be placed to avoid the need for a dialysis catheter. The best way to prevent the use of dialysis catheters is to follow-up with your family doctor and nephrologist regularly.

The creation of dialysis access involves connecting a vein to an artery. This is called a fistula. This results in increased flow to the vein. Over time the increased pressure and flow within the vein causes the vein to become thicker and larger or “arterialize”. This is necessary to ensure the access site can tolerate dialysis sessions several times per week. Your vascular surgeon will determine when the vein has adequately matured and is ready to use for dialysis.

Some patients lack veins of adequate size to use for dialysis. These patients will require a synthetic graft to use for dialysis access. The graft is tunneled just under the skin and connected to the artery and vein. These grafts or shunts can be used as quickly as the following day in some cases. However, because they are non-autogenous tissue, they have an increased rate of infection compared to autogenous arteriovenous fistulas. This increased infection risk is why arteriovenous fistulas are preferable to synthetic grafts despite the increased time needed for maturation.

Dr. Jenna Kazil is an exquisite double board-certified vascular surgeon in Manatee County, FL who sees patients at the Florida Surgical Clinic. Dr. Kazil has a long track record of successful fistula creation and management. Patients looking for a first-rate board-certified Bradenton vascular surgeon should contact Dr. Kazil at the Florida Surgical Clinic for any surgical or vascular needs.

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