Patients who require hemodyalisis need vascular access for connection to the dialysis machine. In the emergemt or urgent situation catheters are placed in the neck, chest or groin veins. In the elective situation an artery is connected to an artery in the arms (usually at the wrist or elbow level) called an arterio-venous fistula. When the vein is not available, a synthetic tube (graft) is used. These accesses require anywhere from two weeks (graft) to several months (fistula) of healing and development (maturation) before they can be used. Every effort is made to create a fistula whenever possible. Fistulas last longer and have less risk of infection.
An ultrasound of the arms before access surgery evaluates the arteries and veins and helps to plan the procedure. It is ideal to arterio-venous fistula surgery several months before need for hemodialysis. This is usually determined by the patient's nephrologist (kidney doctor).
Most peripheral vascular conditions can be diagnosed and monitored with Duplex scan which combines real time ultrasound of blood vessels with color flow and Doppler spectral analysis of blood flow. Plaques and aneurysms can be visualized in veins and valvular dysfunction can be determined based on blood flow.
Vascular Laboratories that meet the highest standards, such as the one in my office, are accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL).
Surgery is recommended for arteries at great risk for rupture: those over six centimeters wide, and those four to six centimeters wide in patients in good health otherwise.