The Integral Role of a Vascular Surgeon in Dialysis Patients’ Treatment Journey

Introduction

For those suffering from advanced kidney disease, dialysis can be a necessary and lifesaving treatment. Dialysis assists in filtering waste, removing excess fluids, and balancing chemicals in the blood when the kidneys can no longer perform these functions. Hemodialysis requires the creation of an access point for blood flow, making the role of a vascular surgeon vital in this process. In this blog, we will discuss the importance of vascular surgeons in the dialysis treatment journey, the types of dialysis access points, and the role of vascular surgeons in hemodialysis access.

What Is Kidney Dialysis?

When the kidneys are unable to carry out their essential function of purifying the blood, dialysis becomes a lifesaving treatment. Dialysis, either through a machine (hemodialysis) or a membrane in the abdomen (peritoneal dialysis), filters waste, removes extra fluid, and balances the chemicals in the blood that kidneys can no longer process.

Hemodialysis Dialysis Access: Fistula and Graft

Before commencing dialysis, a vascular access point must be surgically created for the blood to flow in and out of the body. This procedure is performed by a vascular surgeon—a doctor specialized in treating the circulatory system. These surgeons usually create a surgical access point in the arm or wrist by connecting an artery to a vein. This however takes time to develop in size or mature. In case dialysis is required earlier, a central vein catheter ( Double Lumen Catheter or DLC) or a tunneled catheter ( Permacath) can be inserted into the major veins in the neck to facilitate dialysis.

Different Types of surgical access points

AV Fistula Access for Dialysis:

The arteriovenous or AV fistula is the most durable access point for dialysis. To create this, a surgeon connects an artery directly to a vein. A fistula is more durable than a graft and is less likely to get infected. However, the procedure must be done months before dialysis commences because the fistula needs time to heal and strengthen.

Basilic vein Transposition:

if the superficial veins are unsuitable for AV fistula, or in case of AV fistula blockage, clotting or thrombosis, a durable surgical procedure called Basilic Vein Transposition ( BVT) is carried out by utilizing a deeper vein, joining it to an adjacent artery and bringing it near to the skin.

Graft Access for Dialysis:

A graft, or bypass graft, is another dialysis access option recommended for people whose veins are smaller or need to start dialysis sooner. During this procedure, the surgeon implants a synthetic tube to connect an artery to a vein.

The surgical procedures for AV fistula is usually done on an outpatient basis, under local anesthesia and takes 40 to 60 minutes.

However, Basilic Vein Transposition or AV graft can be done under regional or general anesthesia and may need observation or admission for 12 to 24 hours. Your surgeon will make a cut on your arm and implant the graft tube or fistula that will connect an artery to a vein.

Hemodialysis Access by Vascular Surgeons

Hemodialysis is a treatment that purifies the blood of a person whose kidneys have failed. This treatment involves routing a patient’s blood through a dialyzer, a machine that filters out waste products and extra fluid. Before hemodialysis can be conducted, a connection must be made to the blood inside the blood vessels. A hemodialysis access, or vascular access, facilitates the passage of blood to the dialysis machine, where it is filtered and then returned to the body.

Also Read: https://www.drsumitkapadia.com/post/types-of-vascular-surgeries/