Dialysis, also called hemodialysis, is the most common treatment for kidney failure. A dialysis machine is an artificial kidney designed to remove impurities from blood. During dialysis, blood is drawn from the patient through the dialysis access already created and is connected to the dialysis machine so it can remove impurities and regulate fluid and chemical balances. The purified blood is then returned to the patient again through the dialysis access. Creating the access portal is a minor surgical procedure. There are two types of portals placed completely under the skin:
ARTERIOVENOUS FISTULA
A surgeon creates an arteriovenous fistula by making a connection between an artery (which carries blood away from the heart) and a vein (which carries blood back to the heart). This artificial connection allows the vein to become larger and for the walls of the vein to thicken, a process termed maturation. A mature fistula makes it easier for the vein to be punctured repeatedly for dialysis. Maturation typically takes three to six weeks to occur, but in rare cases, can take longer. This makes advance planning for an arteriovenous fistula important. Ideally fistula should be created When a patient is diagnosed with kidney failure and is expected to need permanent dialysis in the near future. Arteriovenous fistulas are usually created between radial artery and the vein at the wrist. it can also be done at the fore arm as well as the elbow. An arteriovenous fistula is the preferred type of vascular access due to lower rate of infection and clot formation, resulting in greater longevity than other types of vascular access. This operation can be done under local anaesthesia and no admission is required. However, not everyone is a good candidate for an arteriovenous fistula, particularly older patients and patients with small veins or those who have blocked veins in the upper limb due to previous intravenous injections Basilic vein transposition: This operation is done when no suitable superficial vein is available for an AVF. Basilic vein is placed deep inside the arm. This can be mobilised and moved just under the skin and can then be used as an AVF. This operation needs anaesthesia and hospitalisation. Normally it takes 4-6 weeks for this to mature and be ready for dialysis.
Basilic vein transposition:This operation is done when no suitable superficial vein is available for an AVF. Basilic vein is placed deep inside the arm. This can be mobilised and moved just under the skin and can then be used as an AVF. This operation needs anaesthesia and hospitalisation. Normally it takes 4-6 weeks for this to mature and be ready for dialysis.
