The Integral Role of a Vascular Surgeon in Dialysis Patients’ Treatment Journey
For those suffering from advanced kidney disease, dialysis can be a necessary and lifesaving treatment. Dialysis assists in filtering waste, removing excess fluids, and balancing chemicals in the blood when the kidneys can no longer perform these functions. Hemodialysis requires the creation of an access point for blood flow, making the role of a vascular surgeon vital in this process. In this blog, we will discuss the importance of vascular surgeons in the dialysis treatment journey, the types of dialysis access points, and the role of vascular surgeons in hemodialysis access.
What Is Kidney Dialysis?
When the kidneys are unable to carry out their essential function of purifying the blood, dialysis becomes a lifesaving treatment. Dialysis, either through a machine (hemodialysis) or a membrane in the abdomen (peritoneal dialysis), filters waste, removes extra fluid, and balances the chemicals in the blood that kidneys can no longer process.
Hemodialysis Dialysis Access: Fistula and Graft
Before commencing dialysis, a vascular access point must be surgically created for the blood to flow in and out of the body. This procedure is performed by a vascular surgeon—a doctor specialized in treating the circulatory system. These surgeons usually create a surgical access point in the arm or wrist by connecting an artery to a vein. This however takes time to develop in size or mature. In case dialysis is required earlier, a central vein catheter ( Double Lumen Catheter or DLC) or a tunneled catheter ( Permacath) can be inserted into the major veins in the neck to facilitate dialysis.
Different Types of surgical access points
AV Fistula Access for Dialysis:
The arteriovenous or AV fistula is the most durable access point for dialysis. To create this, a surgeon connects an artery directly to a vein. A fistula is more durable than a graft and is less likely to get infected. However, the procedure must be done months before dialysis commences because the fistula needs time to heal and strengthen.
Basilic vein Transposition:
if the superficial veins are unsuitable for AV fistula, or in case of AV fistula blockage, clotting or thrombosis, a durable surgical procedure called Basilic Vein Transposition ( BVT) is carried out by utilizing a deeper vein, joining it to an adjacent artery and bringing it near to the skin.
Graft Access for Dialysis:
A graft, or bypass graft, is another dialysis access option recommended for people whose veins are smaller or need to start dialysis sooner. During this procedure, the surgeon implants a synthetic tube to connect an artery to a vein.
The surgical procedures for AV fistula is usually done on an outpatient basis, under local anesthesia and takes 40 to 60 minutes.
However, Basilic Vein Transposition or AV graft can be done under regional or general anesthesia and may need observation or admission for 12 to 24 hours. Your surgeon will make a cut on your arm and implant the graft tube or fistula that will connect an artery to a vein.
Hemodialysis Access by Vascular Surgeons
Hemodialysis is a treatment that purifies the blood of a person whose kidneys have failed. This treatment involves routing a patient’s blood through a dialyzer, a machine that filters out waste products and extra fluid. Before hemodialysis can be conducted, a connection must be made to the blood inside the blood vessels. A hemodialysis access, or vascular access, facilitates the passage of blood to the dialysis machine, where it is filtered and then returned to the body.
Role of a Vascular Surgeon in Dialysis Patients
As a gold-medalist from Baroda Medical College and a renowned vascular and endovascular specialist in Vadodara and Surat, Dr. Sumit Kapadia explains the multifaceted role of a vascular surgeon in the care of dialysis patients. Vascular surgeons are integral to the dialysis process, from the initial creation of the vascular access to its regular monitoring and maintenance.
When a patient’s veins are not suitable for an AV fistula, a vascular surgeon might opt for an arteriovenous graft instead. A graft involves using a synthetic tube to connect an artery to a vein. This creates a bridge that can be used for the dialysis procedure. Like fistulas, grafts also require careful monitoring and maintenance to prevent complications such as infection, clotting, or narrowing of the vessels (stenosis).
Beyond creating and maintaining vascular access, vascular surgeons also play a significant role in managing potential complications. They regularly monitor the fistula or graft to ensure its functionality and longevity. They also provide comprehensive care, including the treatment of any problems that might arise from the dialysis access point.
The cost of dialysis fistula surgery can vary widely, depending on several factors, including the patient’s overall health, the type of procedure, and the healthcare provider. Despite the initial costs, a well-functioning and well-maintained fistula or graft can provide substantial long-term benefits, reducing the risk of complications, subsequent hospitalizations, and associated healthcare costs.
Precautions for Dialysis Patients Visiting a Vascular Surgeon
Understand the Procedure:
Knowledge is empowering. Before visiting the vascular surgeon, ensure that you understand the type of dialysis access you will be receiving, whether it’s a fistula, basilic vein, or an AV graft. Don’t hesitate to ask any questions or express any concerns to your healthcare team.
Follow Pre-Procedure Instructions:
Before the procedure, your surgeon will give you specific instructions. These could include fasting, medications to avoid, and other necessary preparations. Following these instructions carefully is crucial for a successful procedure and recovery.
Monitor for Infections:
After the procedure, be vigilant for signs of infection at the surgical site, such as redness, swelling, increased pain, or drainage. If you notice any of these signs, contact your healthcare team immediately.
Regular visits to your vascular surgeon after the procedure are important to ensure the dialysis access is working properly and to detect any potential complications early.
A healthy lifestyle can contribute to better dialysis outcomes. This includes maintaining a balanced diet, exercising regularly, and avoiding tobacco and alcohol.
Undergoing dialysis can be a stressful experience. Don’t hesitate to seek emotional support from friends, family, or mental health professionals. You are not alone, and there are numerous resources available to help you navigate this journey.
Remember, your vascular surgeon and nursing team are there to assist you through each step of the dialysis process. Don’t hesitate to communicate with them about any questions or concerns you may have.
In conclusion, the role of a vascular surgeon in the treatment of dialysis patients is pivotal. From creating and maintaining vascular access to managing potential complications, these specialists ensure that patients receive the best possible care during their dialysis journey. Understanding the various aspects of dialysis access and the integral role of vascular surgeons can help patients and their families prepare for this new way of living with confidence. In Vadodara, experienced and renowned vascular and endovascular specialist Dr. Sumit Kapadia, a gold-medalist from Baroda Medical College, is available to guide patients through their dialysis journey, ensuring they receive the best possible care.