Interventional Radiology

Dialysis Access Management

nterventional radiologists work closely with patients, their nephrologists and their vascular surgeons to help maintain functional hemodialysis access in hemodialysis patients.

In patients with arteriovenous fistulas or grafts, hemodialysis may fail if narrowings, called stenoses, develop in the vascular circuit. Those narrowing cause poor flow, which affects the ability to efficiently dialyze the blood. In some cases, the narrowings can cause additional symptoms, such as swelling of the head and arms. When poor flow is left untreated, it can result in clot formation, which prevents the ability to dialyze and, if not treated promptly, can lead to permanent fistula or graft failure. Interventional radiologists are skilled at treating clots with special devices and by administering clot-dissolving drugs directly into the clot. They are also skilled at treating sites of narrowing with angioplasty and, if appropriate, stent placement.

Another service that interventional radiologists provide for hemodialysis patients is placement of tunneled hemodialysis catheters. Patients with long-standing use of tunneled hemodialysis catheters can eventually develop blockages in the commonly used veins of the neck and chest. Those blockages may make placement of a new catheter challenging. In those cases, interventional radiologists can often open a channel through the blockage to allow placement of a new catheter. If that is not possible, alternative sites such as through the veins draining the legs, through the liver, or through the back can be used for placement of a hemodialysis catheter.

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