In cases of kidney disease and the inability to remove waste products from the blood and excess fluids from the body, the patient requires hemodialysis or peritoneal dialysis. The role of the vascular surgeon in these cases is to provide a means to enable the patient to undergo this procedure by inserting temporary or permanent dialysis catheters or creating arteriovenous fistulas using either the veins of the arms or artificial arteries.
Dialysis patients may also require maintenance and care of their arteriovenous fistulas through surgical interventions for repair or minor adjustments, such as balloon angioplasty or stent placement.
1) Permanent Dialysis Catheters
What are they?
Thin tubes are inserted under the skin into one of the major veins (usually in the neck or chest) to provide an immediate and secure access for hemodialysis, especially for patients who do not yet have a mature arteriovenous fistula.
When are they used?
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Starting dialysis urgently
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While waiting for the AV fistula to mature
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When the patient’s veins are weak or not suitable for creating a fistula
Advantages:
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Ready for use immediately
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More comfortable and longer-lasting than temporary catheters
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Lower infection rates with proper care
How is it done?
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Performed under local anesthesia
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Catheter inserted precisely under ultrasound and X-ray guidance
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Same-day discharge
2) Arteriovenous Fistula (AVF)
What is it?
A surgical connection between an artery and a vein—usually in the arm—creates a strong and durable access point for long-term dialysis.
Advantages:
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The safest and most effective long-term dialysis access
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Lowest risk of infection or clotting
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Provides strong blood flow for efficient dialysis sessions
When is it performed?
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Weeks before beginning dialysis
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In patients with advanced chronic kidney disease approaching dialysis
How is it done?
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Performed under local anesthesia
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A small incision in the arm
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Same-day discharge
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Requires 4–6 weeks to mature before it can be used
3) Fistula Angioplasty / Declotting
What is it?
A minimally invasive procedure used to treat narrowing or blockage in the arteriovenous fistula by using a balloon catheter or specialized tools to remove clots and restore proper blood flow.
When is it needed?
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Low blood flow during dialysis
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Swelling of the arm
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Difficulty inserting the dialysis needles
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Fistula failure or near-complete blockage
Advantages:
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No open surgery
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Restores fistula function immediately
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Reduces the need for new fistulas or catheters
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Same-day discharge
How is it done?
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Performed under local anesthesia
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A thin catheter is inserted into the fistula
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The narrowing is widened with a balloon, or clots are removed
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Brief observation afterward
At Dr. Mohamed Rafeek Saafan’s Clinic
Each patient is evaluated using ultrasound and imaging studies to choose the best approach for maintaining reliable dialysis access. Continuous follow-up ensures early detection and treatment of any fistula problems.
💡 Why choose Dr. Mohamed Rafik Saafan's clinic?
Extensive experience in vascular surgery and diabetic foot treatment.
Utilization of the latest interventional catheterization and microsurgical techniques.
An individualized treatment plan for each patient to ensure optimal results and maximum safety.