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The most common treatment for chronic kidney disease or kidney failure is hemodialysis. Hemodialysis is the process of circulating the blood outside of the body, through a filter system, which removes toxins and purifies the blood (see photo at left). If hemodialysis is required on a long-term basis, your physician may recommend that you obtain permament hemodialysis access.
(Photo licensed under Creative Commons Attribution License. Source: Kbik@en.wikipedia)
If this is the case, a vascular specialist creates an access portal (arteriovenous fistula or graft) into the circulation that enhances blood flow for hemodialysis treatment. This portal is placed below the skin, usually in the arm; however, in certain circumstances, the leg may used instead.
When an arteriovenous (AV) Fistula is created, an artery is sewed together with a vein. It is created by surgically joining an artery and a vein just below the surface of the skin. It takes several weeks to months for the vein portion of the fistula to mature. During this time period, the vessel enlarges and becomes stronger from the increased arterial blood flow. The higher flow in the fistula promotes an easier, more efficient dialysis treatment.
(Diagram licensed under Creative Commons attribution license. Source: Kbik@en.wikipedia)
Before the fistula can be used, a second step is required to bring the fistula closer to the surface of the skin, which enables easier access of the fistula by the dialysis nurse for dialysis treatments. Because of the multi-step process required for the creation of the arteriovenous fistula, your physician may suggest that you undergo creation of the fistula or graft before hemodialysis is required so as not to delay hemodialysis once it is deemed necessary.
A graft (synthetic tube) is sometimes used instead of sewing an artery to a vein if the vein is determined to be too small. It is surgically placed below the surface of the skin to connect an artery to a vein. After placement of the graft, there is still a required amount of weeks to heal before the graft can be accessed for hemodialysis.
(Diagram licensed under Creative Commons Attribution license. Source: Kbik@en.wikipedia)
Both the creation of a fistula or graft for hemodialysis are minor outpatient surgical procedures and do not require an overnight stay in the hospital. Vascular surgeons at UCSF have extensive experience in determining eligibility for hemodialysis access, type and location of the access, as well as placement and follow up care.