A vascular access is considered a kidney failure patient’s lifeline if he/ she is on dialysis. Hemodialysis is a treatment procedure that uses a machine called the dialyzer to perform the normal functions of the failed kidneys, i.e. to remove waste products and excess fluids from the blood. The access is often a vein created surgically to allow blood to pass outside the body, into the dialyzer and flow back into the body once its cleansed by the dialyzer. The vascular access lets large amounts of blood to flow continuously during hemodialysis to make sure that a satisfactory amount of blood is filtered during the hemodialysis. It is usually the vascular surgeons who will create the vascular access in the arm or leg for hemodialysis by placing a shunt surgically, or placing arterio-venous (A-V) fistulae, and grafts that connect arteries to veins.
Vascular surgeon role
In an ideal situation, a patient with kidney failure is referred to a vascular surgeon a few months before starting hemodialysis. This gives the vascular access the time to mature, thus helping to prevent problems such as narrow veins, clotting and low blood flow. The vascular surgeon takes a detailed medical history of the patient and performs a physical examination of both the upper extremities. He/ she measure the blood pressure on both the arms. During the evaluation, you will be asked to undergo a series of tests such as noninvasive vein mapping, done through ultrasound scanning to help the surgeon determine which veins can be used for your hemodialysis access. You will also have to undergo blood tests. It is important to let the surgeon know if you have had any previous surgeries or have a pacemaker. This information is extremely important because it influences the surgeon’s decision on how to create access for your dialysis treatment. Venography, a test to outline the veins, Duplex, a test to examine blood flow in arteries and veins, and arteriography, an imaging test to outline the arteries are now being used frequently by surgeons to develop a fair picture to create the vascular access for dialysis.
Once you have undergone the tests prescribed by the surgeon, he/she will be able to tell you the ideal position for placing the fistula and you can choose a comfortable position for it. You may also have doubts regarding the procedure of the surgery, the care of the fistula and the duration for which it lasts. You are free to discuss these concerns with the surgeon, and he/she will give you suitable solutions.