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Hemodialysis Access Management

No dialysis access is perfect. At one point or another, your access will need some form of maintenance. If you have a dialysis fistula or graft, you may need to deal with narrowing that develop within your access or within the blood vessels that serve it. To address this, a fistulagram is needed to further investigate the anatomy of the access. If needed, an intervention to resolve the issue can often be done at the time of the procedure. If your access “clots off” or “shuts down” then a thrombectomy may be needed. Whatever your needs, most hemodialysis access management cases can be performed in our comfortable and state-of-the-art office based procedure suite.

Fistulagram with Angioplasty and Stenting

If your fistula or graft is not performing well, a fistulagram might be recommended. During a fistulagram, you will receive sedation as well an injections to numb the area over your access. A needle will then be used to cannulate your access. Once accessed, this needle is exchanged for a soft catheter. Contrast is then injected into your access and pictures are obtained with an x-ray machine that is position around you. This helps us see how fast blood moves through your access and helps us find any narrowing that prevents your access from functioning correctly.

Once your access has been analyzed, corrective action for any issues may take place while you are on the procedure table. We have a large collection of balloons, coils and stents to address any blockages or other structural issues that are found.


Sometimes the blood will stop flowing in a fistula or hemodialysis graft. When blood flow slows, the blood in the access will often clot and “plug up” the fistula. If this happens you will need the access “declotted” to be able to receive your dialysis therapy. As with the fistulagram procedure described above, you will be given sedation medicine through an IV to keep you comfortable as we use needlesticks to access your fistula or graft. Using balloons and/or special devices – along with clot-busting medications- we can break up and dissolve the clot so that normal flow can be restored to the access. Again, all of this can be done conveniently in our office, avoiding the expense and frustration of procedures in the hospital – while also possibly preventing an admission to the hospital or a visit to the emergency department.

Catheter Management

We offer multiple dialysis catheter management services as well. This includes new catheter placement, catheter exchange and alteplase treatment of occluded catheters.