End Stage Renal Disease

Also referred to as end-stage kidney disease, ESRD is the most advanced state of kidney disease, resulting in the need for ongoing hemodialysis to “clean out” toxins from the blood. This is more commonly referred to as just “dialysis”. Dialysis is performed through a dialysis access. Minimally Invasive Vascular offers expert, comprehensive and ongoing care for dialysis access such as fistulas, grafts and Permcath™.

Types of Dialysis Access:

Dialysis Fistula

A dialysis fistula is a connection between an artery and a vein, typically in the arm.  This fistula is then used for hemodialysis.  A dialysis fistula can last for many years if treated and maintained properly.  If not properly maintained they can eventually stop working, clot and you may lose this access forever.


A graft can be used to create a dialysis fistula in patients whose veins or arteries can’t be used to create a dialysis fistula, Grafts can typically be seen in either the arm or the leg.  These also require periodic maintenance otherwise they too can stop working, clot off and fail.


Many ESRD patients benefit from utilizing a Permcath when they initially require hemodialysis.  A Permcath is a flexible tube with two access points – one to transport blood from your body to the dialysis machine and the other to return the “cleaned” blood to your body.

Whether you have a fistula, graft or Permcath all of these will typically and eventually have problems during dialysis.

If you or a loved one have symptoms of Dialysis Access Dysfunction and are undergoing dialysis, we encourage you to schedule a consultation to learn more about how Minimally Invasive Vascular can help you manage your dialysis access and improve your overall quality of life.

If you have been told you “need new surgery”, that your access will never mature, will not work, they recommend “abandoning the access” and a new access placed or you have an old access, never used or abandoned and you want to see if we can get it working again or you want a second opinion please give us a call to schedule a consult.  YOU MAY NOT NEED MORE SURGERY!

  • Clotted access “there is no blood flow”, “they stuck the needle in multiple times and they’re not getting any blood back”, “the pulsing stopped”, “they put the stethoscope on it and they don’t hear anything”
  • Prolonged bleeding after dialysis (longer than usual or > 10-15 minutes) “bleeding takes longer than usual to stop”, “there is bleeding around the needles”, “they had to put extra pressure dressing on it to make it stop bleeding”, “it bled all night”
  • “the alarms on the dialysis machine turn yellow or red”
  • Recirculation during dialysis
  • Poor clearances with bloodwork
  • High venous or arterial pressures during dialysis
  • Poor or decreased blood flow during dialysis
  • Poorly or non-maturing arteriovenous fistula (AVF) after 6 weeks, “they still can’t feel the fistula”, “it’s still too small”, “it’s still too deep”, “it’s not getting any bigger”
  • Difficult cannulation with infiltration, “they keep missing with the needle and it hurt”, “they missed and my arm started to swell and hurt and then there was this bruising”
  • Arm, hand, face or neck swelling
  • Dialysis Access, Periodic Clinical Evaluation and Maintenance
  • On-site Diagnostic Duplex Ultrasonography
  • Diagnostic Intra Vascular Ultra Sonography (IVUS)
  • Angiography
  • Venography
  • Fistulography
  • Arterial and Venous Angioplasty
  • Stent Placement
  • Thrombolysis and Thrombectomy
  • Permcath Exchange
  • Fistula Maturation
  • Evaluation for Steal Syndrome