Tri-County Vascular Care Services

Tri-County Vascular Care provides services for patients needing dialysis. Our staff is committed to providing the latest in imaging, diagnostic and interventional services, as well as patient education. We will coordinate with you and your Nephrology care team to develop a plan of care surrounding your patients’ vascular access needs. Our goal as your endovascular center of choice is to maintain, preserve and/or restore dialysis access so patients enjoy a higher quality of life.

    Vessel Mapping

    Vessel mapping is performed prior to fistula or graft placement. This procedure measures and evaluates arteries and veins for successful vascular access creation. Testing may include an ultrasound and a venogram, or x-ray of the veins. A venogram requires insertion of an IV and injection of a small amount of dye.

    AV Fistula Creation

    An arteriovenous (AV) fistula is a natural type of vascular access where the patient’s vein is surgically connected to an artery. The increased blood flow that results from this connection causes the vein to enlarge and the vein walls to strengthen so that needles can be used to access the bloodstream for dialysis.

    Fistula Maturation Determination & Procedures

    Once the fistula is created, it will gradually increase in size over several weeks. Maturation is the term used to describe the changes in the vein that enable the patient’s fistula to be used for dialysis. The doctor will monitor the fistula maturation and perform additional procedures if necessary to determine when it is ready for dialysis.

    AV Graft Creation

    An arteriovenous (AV) graft is a type of access that is usually placed in the arm, but may be placed in the leg, if necessary. An AV graft is the connection of a vein and an artery that utilizes a hollow, synthetic tube. One end of the tube is connected to an artery and the other end of the tube is connected to a vein. As a result, the blood flow through the graft provides a flow rate that will deliver enough blood to provide an adequate hemodialysis treatment.

    Vascular Access Repair & Maintenance Procedures

    The following procedures are done in the vascular center to maintain optimal access function when an indication for evaluation is detected:

    • Angiogram – A picture of the inside of the fistula or graft using x-rays. A local anesthetic is used. A small needle is inserted and dye is injected while x-ray pictures are observed to identify whether an additional procedure is needed.
    • Angioplasty – Performed if a stenosis was observed on the angiogram. A local anesthetic and possibly IV sedation are used. A small catheter with a balloon at the tip is inserted and inflated to stretch the narrowed area. The balloon is removed at the end of the procedure. Sometimes a stent (a metal piece of mesh) is needed to support the vessel walls to keep the access open. The stent will remain inside the fistula or graft and does not move.
    • Thrombectomy – A procedure performed to restore blood flow to a clotted access. A local anesthetic and IV sedation are usually used. The physician may use medications or devices to break up clots and to sweep and suction the clots away.

    Catheter Placement

    The insertion of a tunneled cuffed hemodialysis catheter. A local anesthetic and possibly IV sedation are used. The catheter is placed in a vein in the neck (sometimes in the groin) to obtain access to the bloodstream. A tunnel is created under the skin and leads up to the point where the catheter exits the body.

    Catheter Exchange

    Performed to improve blood flow or when there is an infection present. A local anesthetic and possibly IV sedation are used. The cuff is loosened and a wire is advanced through the catheter. The old catheter is removed and a new one is placed over the wire.

    Catheter Removal

    Will be performed when the catheter is no longer needed. The catheter exit site area is numbed using a local anesthetic. Once the cuff is freed from the tissue, the catheter slides out of the tunnel and removal is complete.

    PD Catheter Procedures

    If the patient chooses peritoneal dialysis, he/she will need a PD catheter, which is a soft, flexible plastic tube about the length of a ruler and the width of a pencil. During PD catheter insertion, one end of the catheter is put into their peritoneal cavity. The rest of the catheter will come through the patient’s lower abdomen, underneath and to the side of the belly button.