Dialysis is a procedure that routs blood through a dialysis machine. This machine filters the blood to remove waste and excess fluid. Then returns the blood to the body. Dialysis access management or dialysis access maintenance encompasses the interventions necessary to keep this very essential dialysis process running smoothly. This includes dialysis fistula and graft declotting interventions.
Dialysis treats patients with renal/kidney failure or renal/kidney complications. This involves the use of artificial blood vessel connections. Dialysis access management ensures these blood vessel connections are in excellent working order. This helps facilitate the dialysis process.
Dialysis access management treats issues including clogging of the blood vessel connections. Clogs happen due to clots or coagulated blood, and narrowing of the blood vessel connections which can occur over time.
To understand the dialysis access management process, you have to first understand dialysis. When a patient has kidneys that are not working properly on their own, a doctor creates access to his or her blood vessels to better ease the blood filtering process. The blood filtering is done by the dialysis machine. These blood vessel connections include fistulas. This involves joining an artery with a vein to create a higher-flow blood vessel, grafts, which are soft tubes placed between an artery and a vein to create a higher-flow blood vessel similar to the ones created by fistulas. Dialysis may use a catheter for access, which is when a narrow plastic tube in a larger vein in either the groin or neck.
Interventional radiology procedures used for dialysis access management keep these connections healthy and functioning. They may include catheter-directed thrombolysis, catheter-directed mechanical thrombectomy, and angioplasty or vascular stenting.
Catheter-directed thrombolysis is when medicine dissolves blood clots that have built up in grafts and fistulas. Catheter-directed mechanical thrombectomy is when blood clots in the grafts and fistulas are instead physically removed or broken up.
Angioplasty and/or vascular stenting is when mechanical devices including medical balloons widen the openings of grafts and fistulas. The aim is to help them remain open, facilitating better blood flow. After the balloons removal, small mesh tubes called stents may used in the grafts or fistulas. This provides extra support for keeping the connections open and flowing.
The specific management procedures the patient needs are discussed in detail by the radiology team. It is important to know that these are minimally invasive, image guided procedures. These procedures maintain excellent dialysis function and minimal disruption to the patient’s life.