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Dialysis Access

dialysis access in vascular clinic singapore

Dialysis is a crucial treatment for patients with kidney failure, facilitating the removal of waste products and excess fluid from the blood when the kidneys aren’t functioning optimally. The success of dialysis largely depends on the quality and reliability of the access point to the bloodstream or the peritoneal cavity.

Haemodialysis involves filtering the blood to remove waste products and excess fluids. The process requires robust access to the bloodstream, typically achieved through arteriovenous fistula (AVF) or arteriovenous graft (AVG).

Arteriovenous Fistula (AVF)

An AVF is created by directly connecting an artery to a vein, usually in the arm. This connection allows the vein to enlarge and strengthen, facilitating easier and more efficient dialysis sessions.

  • Procedure: A surgeon connects a direct artery to a vein. Over time, the vein grows larger and stronger, suitable for repeated needle insertions.

  • Expected Outcomes: Once matured, an AVF provides a durable and efficient access point for dialysis, often with fewer complications than other access types.

  • Benefits:
    • Natural access using the patient's own blood vessels.
    • Lower risk of infections and clotting.
    • Long-lasting, often serving patients for several years.

Arteriovenous Graft (AVG)

If the veins are unsuitable for AVF creation, an AVG is an alternative. This involves using a synthetic graft to connect an artery and a vein.

  • Procedure: A synthetic graft is placed under the skin, acting as a conduit between an artery and a vein.

  • Expected Outcomes: An AVG provides a reliable access point for dialysis, especially for patients whose veins are not suitable for AVF.

  • Benefits:
    • Can be used sooner after placement, often within weeks.
    • Provides a robust access point, especially for patients with smaller or compromised veins.

Peritoneal dialysis uses the lining of the abdomen (the peritoneum) as a natural filter. A catheter is placed in the abdomen to facilitate this process.

Minimally Invasive Laparoscopic

This modern technique involves small incisions and specialized instruments to place the catheter with minimal disruption.

  • Procedure: Through small incisions, surgeons use specialized instruments to position the catheter in the abdomen.

  • Expected Outcomes: A securely placed catheter with minimal surgical trauma, leading to quicker recovery and initiation of peritoneal dialysis.

  • Benefits:
    • Reduced post-operative pain.
    • Faster recovery times, allowing patients to start.
Open

A traditional method where a larger incision is made to place the catheter directly.

  • Procedure: Surgeons make a direct incision in the abdomen to place and secure the catheter.

  • Expected Outcomes: A sturdily placed catheter, ideal for patients with previous abdominal surgeries or complications.

  • Benefits:
    • Direct visualization ensures precise catheter placement.
    • Suitable for a wide range of patients, including those with prior abdominal  issues.

Over time, haemodialysis access points may face complications. Salvage procedures aim to maintain or restore the functionality of the access point, ensuring uninterrupted dialysis treatment.

Endovascular

This involves minimally invasive techniques using catheters and specialized devices to address issues.

  • Procedure: Through small incisions, specialized devices are used to clear blockages or widen narrowed sections of the access point.

  • Expected Outcomes: Restored blood flow and functionality of the access point, ensuring efficient dialysis sessions.

  • Benefits:
    • Minimally invasive, leading to quicker recovery.
    • Targeted approach to address specific issues.
Hybrid

A combination of open surgical and endovascular techniques to address more complex issues.

  • Procedure: Utilizing both surgical and endovascular techniques, surgeons can address a broader range of complications in a single session.

  • Expected Outcomes: Comprehensive restoration of the access point's functionality, ensuring optimal dialysis treatment.

  • Benefits:
    • Versatility in addressing a wide range of complications.
    • Combines the precision of open surgery with the minimally invasive benefits of endovascular techniques.
Open

Traditional surgical methods to address significant complications, often involving direct access to the graft or fistula.

  • Procedure: Through direct surgical access, surgeons can address and rectify major complications, ensuring the longevity of the access point.

  • Expected Outcomes: A fully functional and efficient access point for continued dialysis treatment.

  • Benefits:
    • Comprehensive approach to address major issues.
    • Long-term solution ensuring the durability of the access point.
Seek Expert Care

Dialysis access is pivotal for the success of dialysis treatment. Ensuring its functionality and longevity is paramount for patients’ well-being. If you or a loved one requires dialysis or faces complications with existing dialysis access, it’s essential to seek expert care. Our team offers comprehensive diagnostic and treatment services tailored to individual needs.

CONTACT US

Mount Elizabeth Novena
Specialist Centre

38 Irrawaddy Road
#10-33
Singapore 329563
Tel: +65 6041 0933 

Farrer Park Hospital
Medical Centre

1 Farrer Park Station Road
#08-14 Connexion
Singapore 217562
Tel: +65 6974 8859

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