Dialysis Access Creation – Orbis Vascular

Dialysis Access Creation Options

At Orbis Vascular, our goal is to provide you and your nephrologist with safe, reliable options for hemodialysis access. We offer both minimally invasive endovascular techniques and traditional surgical procedures, tailored to your anatomy and long-term dialysis needs.

Below is an overview of the main access creation options we provide. Your vascular specialist will help you choose the approach that offers the best balance of durability, comfort, and recovery time.

Surgical Fistula

Surgical AV Fistula Creation

A surgical AV fistula is the traditional and most widely used type of dialysis access. During this procedure, a vascular surgeon makes a small incision and directly connects an artery and a nearby vein, usually in the arm. Over time, the vein wall thickens and enlarges as it is exposed to arterial pressure, creating a strong vessel that can be used repeatedly for dialysis.

Surgical fistulas are often considered the gold standard because they tend to last longer and have lower rates of infection compared with grafts and catheters. However, they require good vessel quality and time to mature before being used for regular dialysis treatments.

  • Gold-standard dialysis access when suitable veins are available
  • Lower infection rates compared with catheters
  • Can provide excellent blood flow for efficient dialysis
  • Requires a healing and maturation period before first use
Endovascular Fistula

Ellipsys™ Endovascular AV Fistula Creation

Ellipsys™ is another endovascular approach that creates an AV fistula through a single, small puncture in the skin under ultrasound guidance. Instead of two catheters, Ellipsys™ uses one device to fuse a nearby artery and vein, forming a fistula that can mature for long-term use.

The procedure is typically performed with regional anesthesia, often in an outpatient setting. Because there is no surgical incision, there is minimal disruption of surrounding tissues, which may help reduce healing time and scarring.

  • Single-catheter, ultrasound-guided technique
  • Performed through a tiny skin puncture with regional anesthesia
  • Short procedure time and quick return to daily activities
  • Can be an excellent option when vessels are positioned favorably for fusion
Endovascular Fistula

WavelinQ™ Endovascular AV Fistula Creation

WavelinQ™ is a minimally invasive, catheter-based procedure that creates an arteriovenous (AV) fistula from inside the blood vessels, without the need for a large surgical incision. Using two very thin magnetic catheters—one in a vein and one in an artery—the physician guides the devices under X-ray and connects the vessels with a small burst of energy.

Because the access is created endovascularly, there is less trauma to the arm and usually a shorter recovery time compared with open surgery. Many patients experience less post-procedure discomfort and may return to normal daily activities more quickly.

  • Non-surgical, percutaneous technique using tiny catheters
  • Designed to preserve the natural anatomy of the arm
  • No surgical scar at the fistula site
  • May be an option for patients who are poor candidates for open surgery
Surgical Graft

AV Graft Creation

An arteriovenous (AV) graft is a synthetic tube that connects an artery to a vein when a patient’s own veins are not suitable for a fistula. The graft is placed just under the skin— most commonly in the arm—and provides a reliable site for the dialysis team to access the bloodstream.

AV grafts can often be used sooner than fistulas, which makes them a good option when dialysis must start quickly. Although grafts may have a higher risk of narrowing or clotting over time, they remain an important and effective choice for many patients.

  • Ideal when native veins are too small or scarred for a fistula
  • Typically ready for use sooner than most fistulas
  • Placed under the skin for easy needle access during dialysis
  • Can be maintained with angioplasty or thrombectomy if narrowing occurs
Planning & Evaluation

Vein Mapping for Access Planning

Vein mapping is a detailed ultrasound examination of the veins and arteries in your arms (and sometimes legs or chest) performed before access creation. The test measures the size, depth, and quality of each vessel, helping your vascular specialist determine which access type is safest and most likely to succeed.

Careful planning reduces the chance of failed surgeries and helps preserve veins for future access options. Based on the mapping results, your provider may recommend an endovascular fistula, a surgical fistula, or an AV graft, and will select the best location for placement.

  • Non-invasive ultrasound exam with no radiation
  • Identifies the best vessels for fistula or graft creation
  • Helps avoid unnecessary incisions or failed access procedures
  • Supports a long-term strategy for preserving your veins

The information on this page is for general education only and does not replace medical advice. Your nephrologist and vascular specialist will review your individual health, anatomy, and dialysis needs to recommend the most appropriate access option for you.

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