End Stage Renal Disease, Dialysis Access Surgery
End Stage Renal Disease (ESRD) is the irreversible loss of kidney function. The two most common causes are Hypertension (high blood pressure) and Diabetes. The treatment for ESRD is either Kidney Transplantation, or Dialysis. Dialysis can be done either through the Abdominal Cavity (Peritoneal Dialysis) or through the Bloodstream (Hemodialysis). As Vascular Surgeons, we are asked by Kidney Doctors (Nephrologists) to provide the means (Access) by which Dialysis can be accomplished.
Peritoneal Dialysis is done through a catheter (tube) that is placed in the abdominal cavity. Fluid is instilled into the cavity then drained, allowing for the removal of the body’s toxins. The treatments are self-administered by the patient, on a daily basis.
Hemodialysis, on the other hand is typically done in an Outpatient center, three times a week. In order for the dialysis machine to be able to clean the blood, a means of access to the blood stream that allows for high flow rates is required. A tube can be placed in the Jugular Vein in the neck (Perm-catheter), generally considered to be used for weeks to months. It is preferable however, for durable and prolonged function, to have the access in the arms.
There are two types of access for the arms: fistulas and grafts. Fistulas involve connecting the patients own artery and vein, to create a high blood flow system. There are typically three types of fistulas: Radio-cephalic, Brachio-cephalic, and Brachio-basilic transposition, named for the various connections. The placement of an Arterio-Venous graft on the other hand, involves using an artificial tube that is connected to an artery and vein. Fistulas are generally preferable to grafts, and we as Surgeons, are always committed to whatever we can to place a fistula.