Skip to main content

Venous Disease & Access

NewYork-Presbyterian Hudson Valley Hospital

Interventional Radiology: Dialysis Access Creation and Maintenance

Call for an appointment: 914-734-3737 Find a doctor at NYP Hudson Valley

What is Dialysis?

Your kidneys have an important function: they remove waste and extra fluids in your body, keep safe levels of minerals in your blood such as potassium, sodium, and bicarbonate, and help to regulate blood pressure. When people lose 85 to 90 percent of their kidney function due to chronic or acute health conditions, dialysis can perform some of the duties of the kidney. During dialysis, the blood is circulated through a machine that removes wastes and excess fluids. Patients with kidney failure typically undergo dialysis three times a week, sometimes for years.

To prepare patents for long-term dialysis, surgeons create a dialysis access in the bloodstream under the skin that allows blood to be removed and returned during dialysis. A fistula, the most common type of dialysis access, is made by joining an artery and vein in the forearm. If properly maintained, a fistula can last years or even decades. A graft, a less common type of dialysis access, is made by using a piece of vein taken from the leg, a section of a cow's carotid artery, or a piece of synthetic material, to join an artery and vein in the arm.

Possible Complications

Both fistulas and grafts can become narrowed, clogged, develop clots, or become infected. An access that is not working well can decrease the amount of dialysis you receive. Our interventional radiologists use the following image-guided procedures to identify and remedy these complications:

Fistulagram

A fistulagram is an X-ray procedure to observe blood flow through the fistula and identify blood clots, narrowing (stenosis), or other blockages. During the procedure, interventional radiologists place a catheter in the fistula and inject a special dye that can be seen on an X-ray and highlights the blood vessels and any blockages. If the fistulagram identifies any problems, we may perform one of the procedures below:

Thrombectomy and Thrombolysis

If a blood clot (thrombosis) has developed in a fistula or graft, interventional radiologists can remove it using two minimally invasive procedures: thrombectomy or thrombolysis. During a thrombectomy, the clot is mechanically removed using a catheter equipped with a specialized tip that can break up and remove the clot. During thrombolysis, a catheter delivers clot-dissolving medication directly to the clot to break it up.

Angioplasty

If a fistula or graft is narrowed, it can be opened using an interventional procedure called balloon angioplasty. Using image guidance, interventional radiologists advance an inflatable balloon mounted at the tip of a catheter to the site of the stenosis. As the balloon expands it opens the narrowed vein or artery allowing increased blood flow through the fistula or graft.

Stent

Immediately following balloon angioplasty, interventional radiologists may implant a small, flexible wire mesh tube called a stent to keep the fistula or graft open. Using image guidance, we position the stent at the site where we performed angioplasty and expand it open with a balloon, then deflate and remove the balloon.

FAQ

Patients who are preparing for the procedure should eat a light meal on the night before the procedure, and they should not eat or drink anything after midnight. Our staff will provide you with more detailed information about which medications you may take in days before and on the morning of the procedure. You should arrange to have someone drive you home after the procedure.

When you arrive at the interventional radiology suite we will have you lie on a specialized x-ray table. We will intravenously give you “conscious sedation” medications to help you relax and block any pain. We will inject a local anesthetic to numb your skin and the tissues around the fistula. We will then insert small catheters into the fistula, then inject a dye into the vessels. If this test reveals a blockage or narrowing, we will work to restore blood flow through the area using one of the procedures described above.

These procedures are generally very safe. Some patients develop a bruise at the procedure site, which may become very large and uncomfortable, or temporarily develop a small lump composed of scar tissue as part of the healing process. With angiography and stenting there is a slight risk of bleeding, of the procedure not successfully opening the stenosis, and of a subsequent failure of your fistula/graft. Very rarely, a catheter can damage the fistula/graft, requiring surgery or another radiological procedure.

Depending on how big and where the blockage is in the fistula, the length of time it will take for us to complete these procedures varies greatly from patient to patient, as will the time it takes for you to recover. If you are undergoing the procedure as an outpatient, you may go home after a brief period or you may spend most of the day in the recovery area. Once at home you may drive after 24 hours, and resume normal activities the next day.

Our Approach to Care

Comprehensive and Patient-Centered Care

At NewYork-Presbyterian Hudson Valley Hospital, you, the patient, are at the center of our approach to superior imaging and treatments that meet your individualized needs. Our fellowship-trained Columbia interventional radiologists perform all procedures. We explain the findings to you in easy-to-understand terms and work closely with your health care team so you can make educated and informed choices about your care.

Multidisciplinary Team Approach

Our interventional radiologists collaborate in multidisciplinary teams with NewYork-Presbyterian Hudson Valley Hospital’s highly skilled and dedicated physicians in specialties such as Internal Medicine, Oncology, Surgery, Urology, Women’s Health, Pediatrics, Cardiology, and Pulmonology to provide compassionate care that is specifically tailored to your needs.

Why Choose Us

World-Class Interventional Radiology Expertise

Our board-certified interventional radiologists from ColumbiaDoctors, the faculty practice of Columbia University Irving Medical Center, offer unmatched expertise and experience in the latest minimally invasive, image guided procedures to diagnose and treat disease in the most complicated patients. Our team includes some of the most nationally and internationally renowned and respected interventional radiologists. In addition to caring for patients, they are also involved in the education of residents, fellows and medical students and in a wide range of research endeavors. Our interventional radiologists frequently collaborate with specialists throughout the NewYork-Presbyterian health care network, placing them at the forefront of advanced medical imaging and minimally invasive treatments.

Expertise in Dialysis Access Creation and Maintenance

Dialysis access creation and maintenance procedures require expertise and a cautious approach. At NewYork-Presbyterian Hudson Valley Hospital, our board-certified interventional radiologists from ColumbiaDoctors, the faculty practice of Columbia University Irving Medical Center, offer unmatched expertise and experience in dialysis access creation and maintenance procedures, even in the most complicated patients.

Cutting-Edge Technologies

At NewYork-Presbyterian Hudson Valley Hospital, we are continually committed to incorporating the latest cutting-edge imaging technologies into your care, including X-ray fluoroscopy, computer tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Each new generation of equipment provides better outcomes and reduces the patient’s exposure to radiation.

Empowering Patients with Information

We encourage all prospective patients and their families to learn as much as possible about their medical condition and the available treatment options. Our interventional radiologists are available for consultations to confirm a diagnosis, get a second opinion, or help evaluate their treatment options.

Book Radiology Appointments via NYP.org/Connect

Patients can book Radiology appointments online via NYP.org/Connect as long as the patient has an Epic Order.  Radiology appointments for X-Ray, ultrasound, bone density, echocardiogram, and limited CT and MRI scans.