Evaluation and Treatment of Problematic AV Access

Arteriovenous (AV) access is an important first step for patients with kidney disorders so that they may receive dialysis treatments.

AV access is a surgical procedure that creates a point of access through which blood will be removed from the body during dialysis, processed and purified through an external filter, and returned to the body. Because blood travels in large quantities and quickly during dialysis – an estimated pint of blood is withdrawn and returned to the body every minute – care must be taken so that a patient’s veins do not collapse under the pressure of this high-speed blood flow.

That’s where AV access comes in. There are three ways to obtain access to a patient’s blood vessels in preparation for dialysis:

• The preferred method, an AV fistula, involves surgically connecting an artery and vein in the forearm, essentially rerouting blood flow on its way to the hand from the artery into the vein going back up the arm. The vein is enlarged and strengthened by the additional blood volume so that it can handle dialysis. AV fistulas are long-lasting and less likely to create blood clots or infections.
• However, if a patient’s blood vessels are too small or damaged to accommodate the high rate of speed and quantity of blood traveling in and out of a patient’s body during dialysis, then an AV graft may be selected. In this surgical procedure, a graft (soft, synthetic tubing) is used to connect artery to vein to allow for dialysis. In this case, needles are placed directly into the tubing during dialysis.
• A catheter may be surgically placed into a vein in a patient’s neck, chest, or groin area in order to accommodate blood flow during dialysis. It is considered a temporary solution when dialysis is needed before a patient has enough time to have and recover from an AV access surgery.