Hemodialysis Vascular Access
Creating durable dialysis access — and keeping it working for the long term.
Permanent Surgical Access Creation
Surgically created permanent vascular access options provide the necessary blood flow rates for effective hemodialysis filtration while minimizing long-term complications.
Arteriovenous (AV) Fistula — The Gold Standard
Created by surgically anastomosing a native artery directly to a vein (typically in the non-dominant forearm or upper arm). High arterial blood flow forces the vein to dilate and thicken ('mature') over weeks to months, providing the longest lifespan, highest patency, and lowest infection and thrombosis rates among all access types.
Arteriovenous (AV) Graft
Utilized when native veins are inadequate, small, or diseased. A synthetic or biologic conduit tube is surgically placed beneath the skin to bridge an artery and a vein. Grafts mature faster (viable within 2 to 4 weeks) but carry a higher long-term risk of stenosis, thrombosis, and infection compared to native fistulas.
Temporary & Urgent Vascular Access
When hemodialysis must be initiated urgently or while waiting for a permanent fistula or graft to mature, temporary catheter access is required:
Central Venous Catheters (CVC)
A soft, flexible multi-lumen tube inserted percutaneously into a large central vein (typically the internal jugular vein in the neck). It provides immediate access without needle cannulation.
Tunneled Capped Catheters
For anticipated use exceeding three weeks, catheters are tunneled subcutaneously to reduce infection risks and improve patient comfort, though catheters carry the highest overall risk of bloodstream infection, central vein stenosis, and clotting.
Access Maintenance & Interventional Treatments
To preserve long-term patency and address complications such as stenosis or thrombosis, vascular specialists utilize targeted diagnostic and interventional procedures.
Fistulogram / Angiography
Diagnostic imaging utilizing radiopaque contrast dye to visualize blockages, outflow stenoses, or anatomical obstructions inside fistulas and grafts.
Percutaneous Balloon Angioplasty & Stenting
Minimally invasive endovascular interventions to dilate narrowed stenotic segments or restore patency in thrombosed accesses.
Symptoms, risk factors & self-care for Dialysis Access
Wondering if a procedure is right for you?
We will review your imaging, explain every option — including non-procedural care — and recommend what is safest for you.