DIALYSIS ACCESS MANAGEMENT
At Baltimore Vascular Care, we offer the full scope of care for end-stage renal disease (ESRD). ESRD occurs when the kidneys are no longer able to function. Patients with ESRD need dialysis, an artificial process for removing waste products and excess fluids from the body that are normally eliminated by the kidneys. Kidney failure is the most common cause for dialysis. ESRD patients have typically one of three different types of hemodialysis access: arteriovenous fistula, arteriovenous graft, or a catheter . A fistula is the preferred type of access.
Vein Mapping
Vein mapping is an x-ray test used to determine the diameter, length, and suitability of the superficial veins for placement of a dialysis access. It is performed by injecting contrast into the veins or by use of ultrasound.
Angioplasty, Stenting, and Fistula Salvage
Many poorly functioning accesses suffer from stenosis, which is a blockage or narrowing in the access. To open a stenosis, we may intervene with angioplasty and/or stent placement to improve blood flow. In angioplasty, a small balloon, mounted on a catheter, is inflated within the blood vessel, expanding the narrowed access. If necessary, we may also insert a metal stent to maintain even blood flow throughout the access. For arteriovenous (AV) fistulas that have not "matured" for optimal dialysis treatment, we can provide a series of angioplasty and/or stenting treatments to expand the access. This series of access interventions, performed over the course of a few weeks, is known as fistula salvage.
Thrombectomy and Thrombolysis
For clotted accesses, we offer thrombectomy (or embolectomy), to remove thrombi (blood clots) from the access. Mechanical thrombectomy devices can remove clots from both AV fistulas and grafts, creating a vacuum effect to pull out the clots. Another alternative to remove clots is thrombolysis, which utilizes pharmacological methods to break down or break up these blood clots.
The MILLER Procedure for Steal Syndrome
Steal syndrome is a clinical condition caused by arterial insufficiency distal to the dialysis access (area furthest away from the access). Blood is diverted into the fistula or graft and away from the hand. To correct the balance of blood flow, we offer a banding technique, the Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) procedure to accurately manipulate the access to the proper size and allow for even blood flow. This procedure uses an angioplasty balloon as a sizing dowel, allowing our physicians to band accesses to their desired diameter to treat steal syndrome and high-flow accesses.
Central Venous Catheter Placement
We offer dialysis catheter placement. The catheter is a flexible hollow tube which is tunneled under the skin from the point of insertion in the vein to an exit site on the chest wall. However, catheters are typically only used up to three weeks because they are prone to clotting, infection and kinking. A catheter may be placed while a fistula or graft is waiting to mature. Once your AV fistula or graft is functioning properly, we will safely remove your dialysis catheter.
Peritoneal Dialysis Catheter Placement and Repositioning
Peritoneal dialysis is a process that uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and is flushed out through regular exchanges. We can place the permanent tube, called a peritoneal dialysis catheter, if it is determined that this is the best method of dialysis for you.
