Dialysis Access Surgery
The diagnosis of kidney failure can be life-changing for a patient, with the prospect of long-term dialysis. Dialysis can be performed either via hemodialysis or peritoneal dialysis. Choosing the correct modality of dialysis access is essential and can affect patient’s lifestyles and success rates. Tulane University School of Medicine offers access to the whole spectrum of dialysis, encompassing both vascular and peritoneal dialysis. In addition, we are one of the country’s largest kidney transplant programs. We work in a multidisciplinary team, including nephrologists, interventional radiologists, surgeons, and dialysis nurses, to oversee and ensure that patients get appropriate and successful access. Care of dialysis access requires commitment and patience. We are dedicated to helping treat all the problems that may occur in complex renal failure patients.
Hemodialysis may occur via different accesses. Our surgeons place primary AV fistulas (using native vessels), AV grafts, as well as dialysis catheters. They are nationally recognized for their work in this field. In accordance with KDOQI guidelines, we have a very high (>80%) incidence of primary AV fistula placements. We perform complicated access creations, including transpositions, secondary fistula creations and vascular reconstructions in order to allow the patient to have a successful native fistula. In addition, we have recognized experts in endovascular techniques to help mature and maintain these valuable accesses. We provide emergency coverage for local dialysis centers to deal with dysfunctional or clotted accesses with expedient scheduling.
Peritoneal dialysis (PD) involves using a catheter placed into the abdomen to allow the peritoneum (lining of the abdomen) to help exchange waste products in the blood stream. We offer laparoscopic placement of PD catheters, along with individualized adjuvant procedures such as omentopexy and presternal catheter exit sites to help patients help prevent complications. We frequently obtain PD access for complex patients, including those with previous abdominal surgery and scar tissue or with large hernias. In addition, we offer advanced techniques to deal with catheter malfunction. Our surgeons serve as industry consultants to help design better PD catheters.
Clinical research is a vital component in our mission to provide the latest treatment advances for our patients. Our surgeons have served as principle investigators for numerous national and international dialysis clinical trials. All patients who qualify will be offered the opportunity to participate and thus potential reap the benefits of the most cutting edge technology available.
