Dialysis Access Maintenance & Repair – Orbis Vascular

Dialysis Access Maintenance & Repair

Even a well-constructed dialysis access can develop problems over time, including narrowing, clotting, aneurysms, or poor blood flow. At Orbis Vascular, we offer a full range of minimally invasive and surgical procedures to diagnose issues early and restore healthy function so you can stay on schedule for dialysis.

The services below focus on diagnosing and repairing narrowed vessels, treating clots, and protecting your access for the long term.

Urgent Access Care

Thrombectomy (Blocked AV Fistulas & Grafts)

Thrombectomy is a procedure used to remove blood clots that block an AV fistula or graft. When access suddenly stops working, dialysis treatments can be delayed or cancelled. Rapid clot removal is critical to salvage the access and avoid the need for a new fistula, graft, or temporary catheter.

Using catheters, special devices, and sometimes clot-dissolving medications, the physician breaks up and removes the clot to restore blood flow.

  • Emergency treatment for clotted dialysis access
  • Helps avoid loss of a mature fistula or graft
  • Often performed the same day to keep you dialyzing on schedule
  • Can be combined with angioplasty if a narrowing caused the clot
Imaging & Intervention

Angiograms, Imaging & Angioplasty (Fistulas & Grafts)

Angiograms and access imaging are diagnostic procedures used to evaluate blood flow within dialysis fistulas and grafts. Contrast dye is injected into the access to identify areas of narrowing, blockage, or abnormal flow that may interfere with effective dialysis.

When a significant narrowing is identified, angioplasty can often be performed during the same session. This involves inflating a small balloon inside the vessel to widen it, restore blood flow, and reduce pressure within the access.

  • Identifies narrowed or blocked segments in fistulas and grafts
  • Balloon angioplasty opens vessels from the inside
  • Helps reduce low flow, high pressures, and dialysis machine alarms
  • Supports long-term access function and durability
  • Often performed as an outpatient procedure with quick recovery
Central Vein Therapy

Central Venous Occlusion Treatment

Repeated catheter use, prior lines, or other conditions can cause narrowing or complete blockage (occlusion) of the central veins in the chest. Central venous occlusion may lead to arm and facial swelling, difficulty with catheter function, or challenges in creating new access.

Treatment typically involves endovascular techniques such as angioplasty and, in some cases, stent placement to reopen the vein and improve blood flow. Restoring central venous patency is often essential for successful long-term dialysis access planning.

  • Diagnoses narrowing or blockage of major chest veins
  • Balloon angioplasty and/or stent placement to restore flow
  • Can relieve swelling and improve catheter or fistula performance
  • Helps preserve options for future access creation
Fistula Support

Fistula Maturation Procedures

Some AV fistulas do not enlarge or strengthen adequately on their own. Fistula maturation procedures are targeted interventions designed to help the fistula reach the size and blood flow needed for safe dialysis cannulation.

This may include balloon angioplasty of narrow segments, treatment of side branches that steal blood flow, or other endovascular techniques to optimize the fistula.

  • Supports fistulas that are slow to mature
  • Improves vessel diameter and blood flow
  • Helps patients transition from catheters to fistula use sooner
  • Reduces the risk of early fistula failure
Hand Ischemia

Steal Syndrome Treatment / AVF Revision

“Steal syndrome” occurs when too much blood is diverted through the dialysis access, leaving the hand with poor circulation. Patients may experience pain, coldness, numbness, or even tissue damage in the fingers.

Treatment focuses on improving blood flow to the hand while preserving the fistula or graft whenever possible. This may involve revising the access, banding, or other surgical techniques tailored to the patient’s anatomy and symptoms.

  • Evaluates hand pain or color changes related to access
  • Procedures to rebalance blood flow between the access and the hand
  • Aims to relieve symptoms while keeping the access usable
  • Helps protect hand function and tissue health
Access Safety

Aneurysm Resection and Repair

Repeated needle sticks and high pressures can sometimes cause segments of a fistula or graft to bulge, forming aneurysms. Large or rapidly enlarging aneurysms can thin the skin and raise the risk of bleeding or rupture.

Aneurysm resection and repair involve surgically removing or reconstructing these weakened segments while preserving a safe, usable access whenever possible.

  • Addresses enlarged, bulging areas of the access
  • Reduces risk of skin breakdown and bleeding
  • Can improve cosmetic appearance and patient comfort
  • Often combined with techniques to redistribute needle sites
Access Optimization

AVF Superficialization / Transposition

Some fistulas are located deep beneath the skin or in positions that are difficult for the dialysis team to access. Superficialization or transposition procedures bring the fistula closer to the surface or move it to a more convenient location along the arm.

These surgeries are designed to make cannulation safer and easier, reducing missed sticks and improving the overall dialysis experience.

  • Brings deep fistulas closer to the skin surface
  • Relocates access to a straighter, more accessible segment
  • Helps reduce pain and complications from difficult needle placements
  • Supports long-term, reliable use of a mature fistula

The information on this page is intended for general education and does not replace personal medical advice. Your vascular specialist will evaluate your symptoms, access function, and dialysis needs to recommend the most appropriate maintenance or repair procedure.

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