End State Renal Disease/Hemodialysis
The Division of Vascular and Interventional Radiology at Mount Sinai provides state–of-the-art treatment for creating and maintaining vascular accesses for hemodialysis patients. Within our Division, there are interventional radiologists and vascular surgeons skilled in the latest technology regarding evaluating, creating, and maintaining vascular accesses.
Our physicians are recognized leaders in hemodialysis access maintenance. They have penned numerous publications in major journals on the topic and have served as featured speakers at various hemodialysis conferences. Our nursing and technology staff is also trained to meet your needs and make your visit to our department as comfortable and effortless as possible.
We feel that the team approach best serves the needs of dialysis patients. Monthly multidisciplinary conferences including interventional radiologists, vascular surgeons, nephrologists, and transplant surgeons help formulate the best plan for each patient. Once referred from a nephrologist, the first step typically involves vascular mapping (via ultrasound) to determine which access is optimal for you. In less straightforward cases CT venography, MRI, or conventional venography can be performed. An effort is made to ultimately replace pre-existing catheters with primarily an arteriovenous fistula or, secondarily an AV graft. Alternatively, Mount Sinai Health System is one of the few centers in the country dedicated to placement of the HeRO graft in more complex hemodialysis access cases and acts as a training center for placement of this graft.
Specialized Vascular Access Maintenance Care
Our forte is maintaining vascular accesses once in use. When a problem is detected at a hemodialysis center, we can readily determine the cause and fix any problems found on the same day. Increased bleeding times, inadequate dialysis, and recirculation can often be caused by venous narrowing and can be resolved with balloon angioplasty and/or stent placement. At Mount Sinai, we use new high pressure balloons and cutting balloons specially designed for venous vascular narrowings in hemodialysis patients. This new technology can prevent the unnecessary placement of stents. When absolutely necessary however, self-expanding stents and newer covered stent and flared stent technology designed to decrease the incidence of subsequent narrowing is available.
Ultrasound evaluation is often all that is necessary to determine the cause of and treat a malfunctioning fistula or graft. Working closely with the Vascular Surgery Laboratory ultrasound technicians, we are able to perform balloon angioplasty and coil embolization under ultrasound guidance, a novel approach. When vascular accesses become thrombosed, our team is second to none in our ability to re-open the fistula or graft. Both pharmacologic and mechanical thrombolysis can be performed using anti-clotting agents, such as tPA and heparin and mechanical devices, such as angioplasty balloons and rheolytic thrombectomy catheters. We now also utilize the mini-incision thrombectomy technique for clotted aneurysmal accesses.