Dialysis Access Surgery
For patients with advanced kidney disease requiring hemodialysis, reliable vascular access is essential. Dialysis access surgery creates a pathway that allows blood to be filtered efficiently during dialysis sessions. The two primary types of access are arteriovenous (AV) fistulas and AV grafts.
At The Medical Group of New Jersey, our vascular surgeons perform dialysis access creation, revision, and maintenance using advanced imaging and microsurgical techniques to ensure long-term function, durability, and patient comfort.
Symptom Onset & Initial Evaluation
Patients needing dialysis access typically have chronic kidney disease or end-stage renal failure. Early evaluation by a vascular surgeon is critical to plan for the best access type and location.
During consultation, your surgeon will review:
- Your kidney function and dialysis plan
- Prior access sites or failed fistulas/grafts
- Arm or vein anatomy
- Overall cardiovascular health
Planning is coordinated with nephrology to ensure the access is ready when dialysis begins.
Diagnosis & Preoperative Planning
Evaluation includes detailed vascular imaging to identify the best vessels for access creation:
- Vein mapping (ultrasound): Assesses size, flow, and quality of arm veins.
- Arterial evaluation: Ensures healthy inflow for long-term access patency.
- Review of prior surgical or central line history: Guides site selection.
At The Medical Group of New Jersey, all mapping and preoperative imaging are performed on-site for a seamless, same-day experience.
Treatment
The choice of access depends on individual anatomy and dialysis needs.
Surgical Options
- AV Fistula (Preferred): Connects a vein and artery directly, allowing the vein to enlarge for dialysis needle insertion.
- AV Graft: Uses a synthetic tube to connect the artery and vein when native veins are unsuitable.
- Central Venous Catheter: Temporary access used in emergencies while awaiting permanent access maturation.
Maintenance Procedures
- Fistulogram: Checks blood flow and identifies blockages.
- Angioplasty or thrombectomy: Restores flow in narrowed or clotted accesses.
- Surgical revision: Repairs damaged or failing sites.
Ongoing Management & Long-Term Prevention
Dialysis access requires ongoing monitoring to prevent complications such as infection, clotting, or low flow.
- Routine access checks: Feel for a “thrill” or vibration daily.
- Avoid blood draws or IVs in the access arm to protect veins.
- Ultrasound or fistulogram follow-up: Every 6–12 months or as needed.
- Good hygiene: Clean the site before each dialysis session.
- Report any redness, swelling, or loss of pulse immediately.
Our vascular and nephrology teams at The Medical Group of New Jersey collaborate to ensure safe, continuous dialysis access and optimal vascular health.