Patients suffering from severe kidney failure need an alternative treatment for cleaning and filtering the blood of toxins, similar to the process performed by the kidneys. To this end, the patient’s blood must be passed through a dialysis machine which simultaneously cleans the blood and replaces it at 300ml per minute. The entire process lasts about four hours and the patients must undergo the treatment three times a week. Such output can be achieved by inserting a catheter into the right upper atria, via the neck veins, although this involves putting a foreign body into a sensitive area. The catheter traditionally has a high infection rate which can even lead to the patient’s death.
In order to avoid catheter insertion there is a “Vascular Access for Dialysis” operation. This is performed by connecting a superficial vein to an artery using a fistula. The connection causes the vein to expand, allowing it to supply the large amount of blood need to cleanse the blood. One can pierce the wide vein that develops after the operation any number of times with special needles (like in blood donation) and through them draw the amounts of blood necessary for dialysis. At the end of the dialysis the patient is disconnected from the machine and goes home without any foreign body dangling from his or her neck and can lead a normal life, shower without concern and even go the beach.
If the patient doesn’t have any suitable veins, an artificial vein – a graft – is installed. The Unit’s doctors have accumulated years of experience in performing these operations, today done only under local anesthetic in a day hospitalization framework.
The vascular access for Hemodialysis is access to a life which without it the patient would not survive once the kidneys cease to function. Therefore, after installing the fistula, we must maintain it and the graft because they often tend to become blocked for various reasons. At the Vascular Unit we have a very strict monitoring policy, using ultrasound supervised by specialist doctors with the aim of preventing these blockages.
By and large, the maintenance is the responsibility of the Unit for Invasive Radiology (Angiography) headed by Dr. Anthony Verstandig. Here they use treatment catheters for expanding blood vessels that have narrowed or been eroded during access use and opening blockages using some of the most advanced technology available.
The Vascular Unit at Shaare Zedek serves as a secondary and even tertiary center for operations for dialysis patients from all over the country, some of whom arrive after a number of failed attempts at dialysis access installation. The Vascular Surgery Unit has an international reputation thanks to the many academic papers it produces and its doctors are often invited to address leading conferences in the field.
Some of the unit's services are offered through the Vascular Institute:
1. Admission of patients for duplex-combined tests to map the hemodialysis approach and to monitor the fistulas.
2. A Fistula Clinic for post-operative checks and removal of stitches.
The surgeries themselves are done through the Surgical Day Hospital.
Dialysis Access is access to life and so our aim is to install one access in every patient for life.
Access installations performed at the Unit:
Fistula: A surgical connection of vein to artery. During dialysis, the vein is attached to the artificial kidney through needles. At the end of the treatment all that is needed is to stop the bleeding. The fistula allows the patient to conduct a completely normal lifestyle.
Flattening Veins: When superficial veins erode, we can access the deep veins in the hands or feet in order to install a fistula. The Unit has accumulated a lot of experience in this type of surgery which allows the use of natural veins for dialysis and avoids using a graft.
Graft: When there are no suitable veins, we use an artificial vein called a graft. The linkage method is identical to the fistula connection. We use an innovative graft partly coated on its inside with Heparin to prevent any coagulation.
Access installations conducted together with the Angiography Unit:
Neck Catheter: A device that connects to the upper right atria via the neck vein. This is a temporary installation for hemodialysis – because the catheter is easily infected – until the permanent access is installed.
Dr. David Shemesh
Tests: Main Building, 3rd Floor, Vascular Institute
Operations: Main Building, 2nd Floor, Surgical Day Hospital