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  • HomeDr. Kunal Arora

What is permacath insertion & dialysis AV fistula salvage

Permacath insertion and dialysis arteriovenous (AV) fistula salvage are medical procedures related to vascular access for hemodialysis. They are essential for patients with end-stage renal disease (ESRD) who require regular dialysis treatments to filter and clean their blood.

Permacath Insertion

Permacath is a brand name for a type of tunneled central venous catheter (CVC) used for long-term hemodialysis. It is inserted into a large vein, usually the internal jugular vein, and is tunneled under the skin to reduce the risk of infection.

Procedure Details

1. Preparation:

  • The patient is positioned and prepped in a sterile manner.
  • Local anesthesia is administered to numb the insertion site.
  • Sedation may be provided for patient comfort.

2. Insertion:

  • Ultrasound Guidance: A vascular ultrasound is used to identify a suitable vein, usually the internal jugular vein.
  • Catheter Placement: A needle is used to access the vein, followed by guidewire insertion. The catheter is then placed over the guidewire and positioned appropriately.
  • Tunnel Creation: The catheter is tunneled under the skin to reduce infection risk and secure it in place.
  • X-ray Confirmation: Fluoroscopy or X-ray is used to confirm the correct placement of the catheter tip in the superior vena cava or right atrium.

Advantages of permacath insertion

  • Provides immediate access for dialysis.
  • Suitable for patients with limited vascular access options.
  • Can be used for months to years with proper care.

Dialysis AV Fistula Salvage

Dialysis AV fistula salvage refers to various procedures and interventions designed to maintain or restore the function of an arteriovenous (AV) fistula used for hemodialysis. An AV fistula is a connection between an artery and a vein created surgically, usually in the arm, to facilitate repeated access for dialysis treatments. Over time, AV fistulas can develop complications that may hinder their functionality, necessitating salvage procedures.

Purpose of AV Fistula Salvage

The primary goal of AV fistula salvage is to ensure that the fistula remains open and functional for efficient dialysis. Salvage procedures address issues such as stenosis (narrowing), thrombosis (clotting), and other structural problems that can compromise the fistula's effectiveness.

Common Issues and Treatment Options

1. Stenosis (Narrowing of the Fistula):

  • Angioplasty: A balloon catheter is inserted into the narrowed segment and inflated to widen the vessel.
  • Procedure: Under ultrasound and fluoroscopic guidance, a guidewire and catheter are navigated to the site of stenosis. The balloon is then inflated to dilate the vessel.
  • Stenting: In some cases, a stent may be placed to keep the vessel open after angioplasty.
  • Procedure: Similar to angioplasty, but involves placing a metal mesh tube (stent) to hold the vessel open.

2. Thrombosis (Clot Formation in the Fistula):

  • Thrombectomy: Mechanical or pharmacological methods are used to remove or dissolve the clot.
  • Mechanical Thrombectomy: Devices such as aspiration catheters or clot retrieval devices are used to physically remove the clot.
  • Pharmacological Thrombectomy: Thrombolytic agents (e.g., tPA) are injected to dissolve the clot.
  • Angioplasty/Stenting: Post-thrombectomy angioplasty or stenting may be performed to treat underlying stenosis that caused the clot.

3. Aneurysms and Pseudoaneurysms:

  • Coil Embolization: Used to manage pseudoaneurysms by inserting coils to block off the abnormal vessel segment.
  • Surgical Intervention: In severe cases, surgical repair may be required.

Importance of Permacath Insertion & Dialysis AV Fistula Salvage

Both Permacath insertion and dialysis AV fistula salvage are crucial in the management of patients undergoing hemodialysis:

  • Permacath Insertion ensures immediate and reliable vascular access, essential for urgent dialysis needs and as a bridge to more permanent solutions.
  • AV Fistula Salvage procedures are vital for maintaining the longevity and functionality of AV fistulas, which are the preferred method of vascular access for long-term hemodialysis due to their superior performance and lower complication rates.

By providing secure and effective vascular access, these procedures play a significant role in enhancing the overall treatment experience, clinical outcomes, and quality of life for hemodialysis patients.