Vascular Access Center Procedures

The Vascular Access Centers are dedicated to caring and maintaining your dialysis access. Patients on dialysis understand the importance of blood to be easily taken from a reliable access point. At local Vascular Access Centers, interventional nephrologists perform outpatient procedures to improve access performance. The ideal hemodialysis access is an artery to vein shunt that delivers high blood flow, easy cannulation.

Most fistula failures or graft failures are caused by a narrowing of the blood vessel. If we catch the problem in time, we may be able to keep the access open and working longer.

Angiogram

Overview An IV is inserted into your access and contrast dye is injected. This enables the doctor to see your access and blood vessels using x-ray. If a blockage is seen, the doctor can fix it.

What To Expect When the balloon is inflated, you may feel pressure in your arm. The medications you were given for sedation may help with the symptoms.

Recovery Time You will be monitored for 1 hour after procedure if sedation is given.

Follow-Up When the balloon is inflated, you may feel pressure in your arm. The medications you were given for sedation may help with the symptoms.

Angioplasty

Overview If the doctor determines there is a significant narrowing in your vessel, it may require opening up the narrowed area. A small balloon is inserted through the IV site to treat the narrowed area in the vessel. Once the area is widened, better blood flow is established.

What To Expect When the balloon is inflated, you may feel pressure in your arm. The medications you were given for sedation may help with the symptoms.

Recovery Time You will be monitored for 1 hour after procedure if sedation is given.

Follow-Up You will be monitored for recurrence of the blockage.

Tunneled Dialysis Catheter Placement

Overview A catheter is placed under ultrasound and x-ray guidance. The catheter is used for dialysis until a permanent access can be placed.

What To Expect The area where the catheter will be placed will be cleaned with a special soap to prevent infection. You will be covered with a drape. Ultrasound will be used to locate your vein. The doctor will numb the area with lidocaine. Once an IV is inserted into your vein, medications can be given to relax you and help with any discomfort. The area may be sore afterwards.

Recovery Time Since you will be given medications through the IV for sedation, you will be monitor for 1 hour after the procedure.

Follow-Up No follow up is needed. However, we will help plan a permanent access. Our goal is to minimize the use of a catheter for dialysis.

Catheter exchange

Overview If a catheter is infected or not working well for dialysis, it can be exchanged for a new one.

What To Expect The area of the catheter will be cleaned with a special soap and you will be covered with a drape. The old catheter will be removed. A new catheter will be placed in the same area. You will be given medications for sedation and to help with any discomfort.

Recovery Time Since you will be given medications for sedation, you will be monitored for 1 hour after the procedure.

Follow-Up However, we will help plan a permanent access. Our goal is to minimize the use of a catheter for dialysis.

Vascular mapping

Overview Contrast dye is injected into the veins in your arms and ultrasound is used to map the blood vessels prior to surgery. This is called access planning.

What To Expect The nurse will place an IV in each arm. A tourniquet will be placed to help dilate your veins. Contrast dye will be injected and x-ray will be used to locate your veins.

Recovery Time You will be monitored for 30 minutes after the procedure.

Follow-Up We will send the images to your surgeon and recommend the best access. You will meet with the surgeon and schedule for surgery to create your access.

Catheter removal

Overview Your catheter is removed if it is no longer needed.

What To Expect The area will be cleaned with a special soap. The area where the catheter comes out of the skin will be numbed with lidocaine. You may feel pressure while the catheter is being removed. Pressure is held at the site after the catheter is removed.

Recovery Time After the area is cleaned and there is no bleeding, you will be discharged.

Follow-Up No follow up is needed.

Stent Placement

Overview A small tubular metal support cage is inserted into the blood vessel and left permanently. This keeps the narrowed area from closing down after angioplasty.

What To Expect You may feel pressure and soreness at the area of the stent.

Recovery Time You will be monitored for 1 hour after procedure if sedation is given

Follow-Up You will be monitored for recurrence of the blockage.

Declot/thrombectomy

Overview You access can stop working due to blockages in the vessel and cause clots to build up in the access. This procedure helps to unblock the narrowed areas and pull out clots to get the access flowing again.

What To Expect Your access arm will be cleaned with a special soap to avoid infection. You will be covered with a drape. The doctor with numb the skin with a local anesthetic called lidocaine. An IV will be inserted into your access. Contrast dye will be injected to determine the problem areas. Clots will be removed. Angioplasty is usually needed (see section on Angioplasty). A stent is sometimes needed (see section on Stent Placement). Your access arm may be sore after the procedure.

Recovery Time You will be monitored for 1 hour after procedure.

Follow-Up You will be monitored for recurrence of the blockage.

Adrenal vein sampling

Overview Blood sample is drawn from adrenal veins in patients suspected to have uncontrolled hypertension due to excessive aldosterone (hormone known to cause salt retention and hypertension when produced in excess) production from the adrenal glands.

Renal vein Renin sampling

Overview Renin hormone is obtained from renal/kidney veins in patients with uncontrolled/ refractory hypertension suspected to have renal artery stenosis. This test helps clinicians to decide if the narrowed kidney arteries are physiologically significant.

Arterial and Venous Doppler

Overview Evaluation of flow in arteries in patients with suspected peripheral vascular disease. ABI and vascular Doppler is done in patients before proceeding with diagnostic arteriography.

Hickman Catheter placement

Overview Patients requiring long term chemotherapy/antibiotics can benefit from these catheters.

Arterial angiogram

Overview Evaluation of arteries by injecting contrast in arteries if related to dialysis vascular access especially if the shunt is suspected to be responsible for poor blood supply to the fingers or toes in the limb in which the shunt is present.

Fistula Angiogram

Overview Diagnostic procedure where contrast agent is injected through the graft or fistula to identify the cause problems in blood flow.

Peripheral Venogram

Overview Evaluation of patients with swollen legs suspected to have clots in the leg or in the deep veins in the hip and pelvis. This procedure is done only after a thorough evaluation by the physician. Contrast is injected through the leg veins to obtain information that is not known from Doppler/ultrasound test.

Renal arteriography

Overview In patients with suspected ischemic nephropathy or Renovascular hypertension, narrowing of renal arteries can be diagnosed by selective angiography of the renal arteries. Patients who meet clinical, physiologic and anatomic criteria for significant renal artery stenosis would be candidates for endovascular management.

venaseal (painless approach) to help leaky valves

Overview

varicose veins

Overview

For Patients

Tarrant Vascular Access Center - Fort Worth

500 Lipscomb Street
Fort Worth, Texas 76104
Phone: 1.817.870.26161.817.870.2616
Fax: 1.817.870.2628

Tarrant Vascular Access Center - Arlington

203A West Randol Mill Road
Arlington, Texas 76101
Phone: 1.817.872.03811.817.872.0381
Fax: 1.817.872.0382