Patients suffering from chronic kidney disease or renal failure need to under renal replacement therapy in the form of dialysis. Dialysis forms the lifeline of patients suffering with kidney disease. This dialysis can be performed either as hemodialysis (blood dialysis) or peritoneal dialysis (through the abdomen). For hemodialysis, either a dialysis catheter is placed in one of the neck/ upper limb veins(subclavian vein) or even rarely in the leg veins in the groin, or a artificial joint is created between the artery and vein the upper limb, called as Arterio-Venous Fistula (or AVF for short).
Arterio venous fistulas are the most durable and the best long term solution for hemodialysis. They are prepared by joining a artery and vein together in the forearm or elbow, with the procedure being performed under local anaesthesia.dialysis from the AVF has to wait for atleast 4-6 weeks to allow the vein to mature and be ready to accept multiple repeated cannulations for dialysis. Post creation of AVF, gentle hand exercises with soft rubber ball is encouraged.
Dialysis catheters can be short term or long term. The long term dialysis catheters are tunneled catheters known as Permacath. They are placed under x-ray guidance to ensure proper positioning of the catheters near the heart. The procedure is done under Local anaesthesia and does not involve opening of the chest. Tunneled catheters can last anywhere from 6 months to 2 yrs plus. Dialysis from the Permacath can be started immediately after placement.
The duration of dialysis is decided by the Nephrologist.
Very rarely do complications develop in these AVF or the veins in which the dialysis catheters are placed. AVF stenosis is known to happen and the treatment in this situation is to dilate the stenosis with special balloons with blades. It is better to treat these stenosis before the fistula fails. Every patient on hemodialysis with AVF should under ultrasound dialysis access screening to ensure timely detection and treatment of these problems.
Long term dialysis catheters can cause central vein stenosis (in the innominate vein, Superior vena cava), which in severe forms can lead to upper limb and facial swelling. This too can be dealt with angioplasty, although stenting in this area may be rarely necessary.
Dr Aadarsh Kabra completed his DNB in General Surgery from Apollo Hospitals, Chennai and then DNB super specialty training in Peripheral Vascular Surgery from Jain Institute of Vascular Sciences (JIVAS), at Bangalore, under Dr K R Suresh.
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