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Dialysis Access: AV Access Angioplasty and Permcath Insertion

By Prof. Dr S. Prathap Kumar
Best Vascular Surgeon in Chennai, India

For patients with chronic kidney disease (CKD) who require hemodialysis, reliable access to the bloodstream is essential. This is typically achieved through an arteriovenous (AV) access, a surgically created connection between an artery and a vein. However, these accesses can sometimes become narrowed or blocked, requiring intervention. This blog post will discuss AV access, angioplasty to restore its function, and the role of permcath insertion in supporting CKD patients.

What is AV Access, and Why Does it Get Blocked?

An AV access, usually a fistula or graft, is created to provide easy and consistent access to the bloodstream for hemodialysis. A fistula is created by directly connecting an artery and a vein, while a graft uses a synthetic tube to connect them. These accesses allow for the efficient removal and cleaning of blood during dialysis.

    Unfortunately, AV accesses can develop problems over time, primarily due to:

  • Stenosis: Narrowing of the access due to scar tissue buildup or thickening of the vessel wall.
  • Thrombosis: Blood clot formation within the access, blocking blood flow.
  • Infection: Infections can occur at the access site.

These issues can significantly impact the effectiveness of dialysis and may even require the placement of a new access if not addressed promptly.

The Importance of AV Access Angioplasty

AV access angioplasty is a minimally invasive procedure used to open narrowed or blocked AV accesses. It's a crucial intervention for maintaining the long-term functionality of the access and ensuring effective dialysis treatments.

    During AV access angioplasty:

  • A thin catheter is inserted into the access, usually through a small incision.
  • The catheter is guided to the narrowed or blocked area.
  • A balloon at the tip of the catheter is inflated to widen the vessel.
  • A stent (a small mesh tube) may be placed in the vessel to help keep it open.

    AV access angioplasty offers several benefits:

  • Restored blood flow: Opens narrowed or blocked vessels, restoring adequate blood flow for dialysis.
  • Improved dialysis effectiveness: Ensures efficient blood cleaning during dialysis treatments.
  • Prolonged access lifespan: Helps maintain the functionality of the existing access, avoiding the need for a new one.
  • Minimally invasive: A less invasive procedure compared to surgery, with quicker recovery times.

How Permcath Insertion Supports Patients with CKD

A permacath (or permanent catheter) is a type of central venous catheter that can be used for hemodialysis access when a fistula or graft is not available or suitable. It's a temporary or semi-permanent option, usually inserted into a large vein in the neck or chest.

    Permcaths are used in specific situations, such as:

  • When a fistula or graft is not yet mature: Fistulas can take several weeks or months to mature before they can be used for dialysis. A permcath may be used in the interim.
  • When a patient's vessels are not suitable for a fistula or graft: Some patients may have damaged or narrowed veins that cannot be used to create a fistula or graft.
  • When a patient needs immediate dialysis access: In emergency situations, a permcath can be inserted quickly to provide immediate access for dialysis.

While permcaths can provide a lifeline for patients needing dialysis, they are associated with a higher risk of infection and other complications compared to fistulas or grafts. They are generally considered a temporary solution until a more permanent access can be created or matures.

Maintaining a functional dialysis access is paramount for patients with CKD undergoing hemodialysis. AV access angioplasty plays a vital role in preserving access function and ensuring effective dialysis treatments. Permcaths provide a crucial alternative when other access options are not feasible. Regular monitoring and proactive management of dialysis access are essential for optimizing patient outcomes and quality of life. If you have any concerns about your dialysis access, it's vital to discuss them with your nephrologist or dialysis team.