People who have been diagnosed with kidney failure need another method to filter the blood and toxins out of their body. To perform dialysis, there are two primary methods in which the toxins can be cleaned out: hemodialysis and peritoneal dialysis.
Peritoneal dialysis is performed through a catheter placed into the abdomen. Fluid is flushed into the abdomen and left to "dwell" over several hours and then drained. This can often be performed at night in the patient's home. This takes a significant amount of preparation and training to perform but is often a good choice for motivated patients. The catheter for peritoneal dialysis can be placed using a laparoscope and requires only two very small incisions. CRL surgeons are specialists in this procedure.
Hemodialysis access involves extracting blood out of the body and filtering it through machine that extracts extra fluid and corrects the chemicals in the blood. In order to remove blood from the body, needles are placed into the skin into a vessel that is prepared for dialysis. One method for preparing access is called a fistula. To create this, a small incision is made on the arm and a vein is connected to one of the arteries in the arm. This vein then enlarges over time and can be stuck over and over to perform dialysis. This method is preferred by CRL surgeons as the best type because of its longevity (often many years) and low resistance to infection.
Another type of vascular access is called a dialysis graft. It is used when a suitable vein is not available. It is not as desirable because of its higher risk of infection and because it does not last as long as a fistula. To create this, an artificial tube is tunneled between an artery and a vein. This tube is then stuck with needles to perform dialysis.
The third type of hemodialysis access is accomplished by placing a silicone catheter in one of the veins of the neck. The catheter is then tunneled under the skin and its ends are situated on the chest wall. This allows for a patient to be connected to the dialysis machine directly. It is a desirable method for access in patients who have rapid deterioration in their kidney function and need dialysis quickly. The patient can be placed under local anesthesia by CRL Interventional Radiologists.
In summary, CRL surgeons specialize in placing dialysis access with a commitment to creating dialysis fistulas first. Additionally, we employ an aggressive monitoring program to help extend the life of the access as this is often a lifeline for patients on dialysis. When dialysis access is showing early signs of failure, CRL Interventional Radiologists can perform angiographic studies and correct blockages within the access. This will prolong the life of the access and extend the dialysis patients’ quality of life.
Interventional Treatments for PAD
Percutaneous Transluminal Angioplasty (PTA) - a tiny balloon is placed in the blood vessel at the site of the blockage. It is then inflated to open the blood vessel.
Stents - a tiny metal cylinder, or stent, is inserted in the clogged vessel to act like a scaffolding and hold it open.
Thrombolytic therapy - clot-busting medications are delivered to the site of blockages caused by blood clots. These medications are often combined with another treatment such as angioplasty.
Stent-grafts - a stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.
Surgical Treatments for PAD
Surgical treatment for PAD today is well standardized, and the outcomes are quite good.
Thrombectomy- this procedure is used only when symptoms of PAD develop suddenly as a result of a blood clot. In the technique, a balloon catheter is inserted into the affected artery beyond the clot. The balloon is inflated and pulled back, bringing the clot with it. Thrombectomy usually requires surgery.
Bypass grafts- in this procedure, a vein graft from another part of the body or a graft made from artificial material is used to create a detour around a blocked artery.
Endarterectomy- these procedures are performed by creating a direct surgical opening of the artery, and removing or excising the plaque which narrows the artery. The artery is then closed leaving it with a normal diameter, allowing blood to flow easily.