At Texan Vein & Vascular we want to ensure our patients undergoing hemodialysis are getting the best treatment plan possible. Hemodialysis requires access to the blood flowing inside the blood vessels so it can be withdrawn and cleansed. Repeated needle puncture is very hard on veins and arteries, however. Special surgical techniques must be used to create an area that can be used for repeated blood access and as a double-board certified vascular surgeon, Dr. Vinit Varu has the expertise to ensure you have the right option chosen for you. He will work intimately with your Kidney specialist to make sure your dialysis needs are taken care of.
Dialysis Treatment Options
While still in the hospital, many people undergo hemodialysis using a catheter placed into a large vein in the neck region. Since the catheter is placed directly into the circulatory system, it may provide a route for infection and is not a long- term solution. Central Venous Catheters (CVCs) in place longer than two to three months may lead to complications such as vein narrowing or clotting. Long-term hemodialysis patients will need other, longer-lasting solutions.
One method is the creation of an arteriovenous fistula. In this technique an artery and a vein are sewn together. Arteries carry blood at high pressure away from the heart into every part of the body. Veins collect blood and carry it at low pressure back to the heart. Attaching the artery to the vein causes the vein to balloon out as high-pressure blood flows directly into it from the artery. About six weeks after operation, the vein grows tougher and thicker. This fact, along with the increased size, make the vein ideal to use for hemodialysis access.
When the AV graft is implanted, two small incisions are made (AV grafts are commonly placed in the forearm, but they can also be placed in the upper arm or the thigh if necessary). A tunnel is made under the skin to aid in the placement of the graft. One end of the graft is sewn to the artery and the other to the vein. Blood will then flow rapidly from the artery through the graft into the vein. Historically, grafts would require 4 weeks until able to be accessed, but recently the technology has evolved to allow dialysis the same day the grafts are implanted, supplanting the use of catheters.
What To Expect
You will experience some bruising, swelling and discomfort in your arm. This is normal and pain medication may be prescribed. Your doctor will give you specific advice, but in general these steps should be followed after you are released from the hospital:
Keep the arm extended and elevated above the level of the heart; place it on a pillow while lying down and hold it up while sitting.
Avoid putting any pressure on the arm or swinging it around.
Rest, follow your diet, and take your prescription medicines.
Perform specific exercises, such as squeezing a ball to help the vein grow
When the graft is new there may be bleeding into the tissue surrounding the graft after the needle is removed. The chance of this occurring will diminish as your body heals around and into the graft.
Do not compress the graft or fistula with tight clothing, bracelets or watches because blood flow might be stopped. Similarly, do not rest a heavy load against it, like a bag of groceries, or sleep on it. And do not have your blood pressure taken in the arm with the graft or fistula because the pressure cuff may stop blood flow.
How Long Do Grafts Stay Open?
On average, grafts stay open about a year. It is difficult to predict because some grafts become blocked after only a few months while others may stay open for years. You will know when the graft is blocked because the swishing noise and vibration (bruit and thrill) stop. Blockage usually occurs because scar tissue forms where the graft is connected to the vein. This slows the blood flow and produces a clot. When this happens, it is not dangerous, but it does require another trip to the Cath lab where the scar tissue and clot are removed and the graft is repaired.