Dialysis Access Management

Arteriovenous fistula/graft evaluation • Revision and de-clot procedures • Hemodialysis catheter placement and exchanges • Peritoneal dialysis catheter placement • Percutaneous AV fistula creation

Dialysis is a treatment that performs some of the functions normally done by healthy kidneys: removing excess water and toxins from the blood for patients whose kidney function, for a variety of reasons, is compromised. There are primarily two type of dialysis: hemodialysis and peritoneal dialysis.

In hemodialysis, blood goes through a filter, called a dialyzer, outside your body. A dialyzer is sometimes called an “artificial kidney”. This type of dialysis is carried out by connecting you to the dialyzer by means of an arteriovenous fistula (AVF) or graft (AVG) or a tunneled dialysis catheter (TDC).

In Peritoneal Dialysis, a cleansing fluid (dialysate) is circulated through a soft plastic tube (catheter) into the abdominal cavity (peritoneal cavity). As the dialysate encounters the lining of the abdominal cavity (peritoneum), it absorbs waste and fluids from blood vessels and is then discarded by draining back out through the catheter. This specialized catheter is called a peritoneal dialysis (PD) catheter.


The fastest way to provide hemodialysis to a patient is via placement of a TDC. This is done under local anesthesia and moderate sedation by inserting the catheter through the skin of the upper chest, tunneling it to the neck area and finally placing it inside the internal jugular vein. This is a short procedure, and patients can be dialyzed the same day. This is a good option for short term access. However, over the long term, these catheters can get infected and lead to sepsis and hospitalization. We place, exchange, and remove tunneled dialysis catheters in a very efficient fashion to minimize your time away from treatment. 

Patients with advanced renal failure commonly undergo creation of an AVF either surgically or through a small pinhole incision in the skin (see PAVF below) just prior to needing dialysis or soon after. An AVF is a vascular connection between an artery and vein of the arm or leg; creating a circuit of blood that circulates blood rapidly to and from the heart. The dialyzer machine cannulas or needles are introduced into the arterial and venous side of the AVF or AVG circuit to allow the blood to be pulled, filtered, and then returned to the body. Traditionally, AVF and AVG have been created surgically. We do not create surgical AVF or AVG, but our specialty is best equipped to perform high-quality endovascular procedures that help these vascular circuits remain functional for as long as possible. We are experts in balloon maturation, angioplasty, stenting and declot procedures. These procedures help with fistula maturation, resolution of narrowed or obstructed areas, and removal of blood clots that may hinder the function of your vascular access.

We are proud to be the first medical practice in the Space Coast to offer the percutaneous AVF (PAVF) procedure, a new FDA approved, minimally invasive technique for creating a connection between an artery and vein in the arm for dialysis access. The PAVF procedure is performed as an outpatient procedure and avoids the large incisions and resulting scars seen with surgical AVF. PAVF have been shown to mature faster than the surgical AVF, usually within 60 days, and require less maintenance procedures to ensure function.