Dialysis Access

If your kidney fails because you have high blood pressure (hypertension), diabetes, or some other illness, our experts at Mount Sinai may recommend dialysis treatments or a kidney transplant. Dialysis, also called hemodialysis, performs the function of the kidneys by cleaning the blood and getting rid of toxins and excess fluid. Our vascular surgeons have extensive experience providing access for patients who need dialysis treatment.

To perform dialysis, doctors surgically create a vein that allows us to use a dialysis machine to filter your blood outside your body. We then return the filtered blood back to your body through a different access point. At Mount Sinai, we can perform different types of surgical procedures to create the access points you may need for dialysis treatment.

The most ways we provide dialysis access are:

• Arteriovenous (AV) fistula is a direct connection between an artery and a vein. We prefer this approach if possible because as the fistula gets bigger and stronger, we can use it to perform dialysis for years with minimal risk of infection. Once we create the fistula, it can take weeks to months before it matures enough to be used for hemodialysis. We will train you in ways to keep the fistula strong, including using exercises such as squeezing a rubber ball, to strengthen the fistula.
• Arteriovenous (AV) grafts involve connecting a vein to an artery using a soft plastic tube (catheter). When the graft heals, we place two needles in the graft to perform dialysis. Grafts need regular attention and upkeep. Usually we offer AV grafts for patients whose veins aren’t appropriate for an AV fistula.
• Perm-cath is appropriate for patients who need dialysis urgently but don’t have either a mature fistula yet or a well-healed arterial-venous graft. We position this catheter into one of your large neck veins, then we tunnel it under your skin and out your upper chest. Perm-caths are not permanent options for dialysis, and they need even more attention than the other approaches to avoid infection and malfunction.