The San Francisco Vein and Vascular Institute offers expertise and convenience to patients suffering from End-Stage Renal Disease (ESRD).
Suffering from kidney failure is a life-threatening health issue. The kidneys, among other things, serve to remove excess water and the waste products of metabolism from your body. So, when your kidneys fail, the buildup of wastes and excess water in the body literally becomes poison.
Chronic kidney disease typically progresses slowly. It is not noticeable to patients in its early stages, because of the body’s remarkable ability to compensate for it. But once it progresses past a certain point, an affected patient will become very ill, and die, in the absence of effective, prompt treatment. And unfortunately, for the vast majority of patients suffering from ESRD, there is no known treatment that will restore the chronically-damaged kidneys themselves to health.
Patients with ESRD are managed primarily by a specialist in kidney disease–a Nephrologist. While the best ultimate treatment for ESRD is a kidney transplant, for a patient who wants one, getting a kidney transplant requires a long wait, and is not always possible or safe. Hemodialysis comes into play here. Hemodialysis (HD) is not a treatment for the kidneys themselves: it is a substitute. HD uses a dialysis machine to remove the wastes and excess water from your body. Usually, patients on HD go to a Dialysis Center three days a week, and receive treatments requiring about 3 1/2 hours each.
HD requires a way to get almost a pint of blood per minute out of your body, run it through the machine, and put the blood back into you. This requires what is termed a “hemodialysis access.” The Vascular Surgeons at SFVVI have considerable expertise in creating and managing dialysis access. Our senior Surgeon has over 30 years of experience. HD access needs to be customized according to an individual patient’s needs and vascular anatomy, among other things. HD access involves surgical procedures, and once an access is in place, it requires periodic maintenance and/or replacement. This is often a complex process.
There are various types of HD access: There are double-barrel catheters that are placed in large central veins, and brought out through a tunnel on the chest wall. They can be used right away, but have serious long-term risks of severe infection and vein clotting (thrombosis). An arteriovenous fistula (AVF) is a surgically-created connection between an artery and a vein in the arm. An AVF requires weeks or months after surgery to be useable, but for the most part it is the most durable form of access. AVF’s may require occasional or even frequent re-interventions, however. In many patients who do not have adequate veins for an AVF, we implant an artificial blood vessel under the skin of the arm, or occasionally leg, that connects an artery to a vein. This form of access, called an arteriovenous graft (AVG) is much safer than catheters, and ready to use sooner than an AVF, but as a rule, requires more re-interventions than does an AVF. There are situations in which patients start dialysis with both a catheter and an AVF or AVG–the catheter for the short term and the graft or fistula for the longer term.
Some patients with especially difficult to treat anatomy are candidates for access utilizing the HERO device which combines a traditional graft with a unique venous component catheter that traverses diseased venous segments that would prevent placement of the traditional AVG.
At SFVVI, we understand that life on dialysis can be challenging, and that the problems often associated with access represent a large part of this. Thus, one of our primary goals is to make the process of creating and maintaining access as easy as possible for the PATIENT and their family. We strive to create an access in each patient that will require the minimum amount of maintenance and repeated procedures. We have an array of access maintenance services such as vascular ultrasound, fistulagrams, angioplasty, and declottings that we perform right here at the Institute. Patients no longer have to spend a day at the hospital being taken from one department to another for various studies and procedures. We offer integrated care for HD access under one roof!