Endovascular Maintenance of Hemodialysis Access

Despite the advancements in dialyzer coil technology, the weak link in the dialysis circuit remains the type of vascular access the patient has.

Nephrologists at Yale-New Haven Hospital reported on some of the earliest methods of monitoring the dialysis access. Once a clinically significant stenosis is identified, most patients' first line of therapy is endovascular treatment. At YNHH, physicians utilize recent technological advancements to prolong the patency of the hemodialysis access, including high-pressure angioplasty balloons, cutting balloons and vascular stents covered with Gore-Tex.

When the graft or fistula fails, YNHH interventionalists remove the thrombus, using mechanical or pharmaco-mechanical methods. Then, the underlying anatomic cause of the access failure is treated with balloon angioplasty and sometimes stents in an effort to prolong patency. Recently, YNHH has been a part of a clinical trial involving the use of a new heparin -coated Gore-Tex stent at the site of vessel stenosis.

When peripheral access is no longer possible, catheter access is often the only option left for hemodialysis access. YNHH physicians perform problem catheter access including reopening of occluded veins and novel access solutions such as translumbar and transhepatic routes, utilizing advanced imaging techniques to guide puncture of the vein and subsequent placement of the device.