Vascular Access Management
Vascular Access Management
Dialysis is a life-sustaining treatment for patients with kidney failure, where the kidneys can no longer effectively remove waste, excess fluid, and toxins from the blood. To perform dialysis safely and effectively, a reliable vascular access is essential. This allows blood to:
- Flow out to the dialysis machine for filtering
- Be safely returned to the body
At CVSKL, we provide comprehensive vascular access care—from creation to maintenance—ensuring your dialysis treatment remains safe, effective, and long-lasting.
Types of Dialysis Access
There are three main types of vascular access:
- Arteriovenous fistula (AVF) – preferred long-term option
- Arteriovenous graft (AVG) – alternative when veins are not suitable
- Central venous catheter (Permcath) – temporary or bridging access
Each option is carefully selected based on your condition, blood vessels, and treatment needs.
What is an Arteriovenous Fistula (AVF)?
An arteriovenous fistula (AVF) is a surgically created connection between an artery and a vein, usually in the arm. This creates a strong, high-flow vein that can be used repeatedly for dialysis.
How Does It Work?
- A nearby artery and vein are connected
- Increased blood flow causes the vein to become larger and stronger
- Over time (weeks to months), the vein “matures” and becomes suitable for dialysis
Why It Is Preferred
- Long-lasting access
- Lower risk of infection
- Better performance for long-term dialysis
Who Needs It?
AVF is the first-choice option for patients requiring long-term haemodialysis, provided suitable blood vessels are available.
What is Arteriovenous Graft (AVG)?
An arteriovenous graft (AVG) uses a synthetic tube to connect an artery to a vein. It is used when a patient’s natural veins are not suitable for a fistula.
How Does It Work?
- The graft is placed under the skin
- It acts as a bridge between artery and vein
- Dialysis needles are inserted into the graft during treatment
Benefits
- Suitable for patients without good veins
- Can be used sooner than a fistula
What is Permcath?
A permcath is a tunnelled dialysis catheter used to provide access to the bloodstream. It is usually a temporary or bridging solution, especially when:
- Dialysis needs to start urgently
- A fistula or graft is not yet ready
How Does It Work?
- Inserted into a large vein (usually in the neck or chest)
- The catheter passes under the skin before entering the vein
- Blood flows through the catheter during dialysis
When Is It Used?
- Urgent or short-term dialysis
- While waiting for AVF or AVG to mature
- When other access options are not suitable
What We Treat
What is Fistula Angioplasty?
Over time, an AV fistula may develop narrowing (stenosis), which reduces blood flow and affects dialysis. Fistula angioplasty is a minimally invasive procedure used to reopen the narrowed area and restore function.
When Is It Needed?
You may need angioplasty if there are signs such as:
- Reduced dialysis flow
- Increased pressure during dialysis
- Weak or absent “thrill” (vibration over the fistula)
- Previous clotting
Why It Matters
- Restores proper blood flow
- Helps the fistula continue to function
- Often allows same-day return to dialysis
How Does It Work?
- A small catheter is inserted into the blood vessel
- A balloon is guided to the narrowed area
- The balloon is inflated to widen the vessel
In some cases:
- Special balloons or stents may be used
