Dialysis Access Management

Dialysis, or the purification of the blood in place of the kidney’s traditional function, is an important aspect of vascular treatment that serves to optimize vascular and venous treatment, thereby ensuring a patient’s overall wellbeing. Several diagnoses and treatments require dialysis access.

AV Fistulagrams and Treatment

An arteriovenous fistula (or AV Fistula), which can also be a graft, is a connection between an artery and vein in the arm or leg created by a surgeon and used for dialysis treatment. Sometimes, blockages or narrowing can occur and impede dialysis treatments.

By administering contrast dye for imaging of the graft or fistula, and then performing a balloon angioplasty (or stenting, if indicated), a physician is able to access the patient’s graft or fistula to determine why it may not be functioning properly.


A thrombectomy is a process by which a physician restores blood flow to the graft or fistula that has clotted. When an access is clotted, the patient is unable to feel the thrill and/or hear the bruit and needs to inform their dialysis center immediately.

A thrombectomy can be performed using catheter aspiration to remove the clot via suction, a mechanical catheter that breaks up and removes the clot, or by administering an intra-access thrombolytic.


Maturations become necessary when a graft or fistula between an artery and vein does not “grow” properly and cannot be accessed. Thus, the surgeon or physician will then “balloon” areas in the graft or fistula to help tight areas to mature.

In other cases, the graft or fistula may not grow due to nearby accessory veins stealing blood flow. In that case, the maturation process may include coiling those veins to divert blood flow back to the fistula.

Vein Mapping

Using ultrasound technology, vein mapping is the process of creating a picture or “map” of all of the veins in a patient’s arm(s) or leg(s). By mapping these areas, a physician can determine the flow of blood, as well as the diameter and length of the veins in question.

Vein mapping is used to better determine where to surgically place a fistula prior to dialysis, as not all veins are suitable for fistula placement.