Our Services

Dialysis Access Procedures

Patients with kidney failure require dialysis, an artificial process of removing excess fluids and toxins from the blood usually eliminated by the kidneys. Dialysis is done when the kidneys are unable to function naturally. Patients who receive dialysis require dialysis or vascular access, which is a way to reach the blood during dialysis treatment.  With the access, blood is removed from the body and travels through soft tubes where it’s purified or cleaned by a dialysis machine (a dialyzer) and returned to the body.  The access is placed by a minor surgical procedure and can be put in the arm or leg. Getting access ready for dialysis can take a few weeks or months. For dialysis treatment to succeed, the access has to function well. If it’s not working properly, minimally invasive procedures can correct it.

At Carolina Vascular Care, we specialize in minimally invasive procedures to maintain and manage vascular access. The procedures are done in an outpatient setting. Our team of professionals customizes treatment plans to meet every patient’s unique needs using the most cutting-edge techniques to quickly restore normal function to your dialysis access. We use the following procedures:

Preoperative Vascular Ultrasound

When the nephrologist has determined that a patient requires dialysis, an ultrasound of the blood vessels in the arms helps the nephrologist to determine which arm and blood vessels can be successfully used to create access.


If the access (graft or fistula) is not working properly, an X-ray may be taken to diagnose the cause of the problem. A needle is inserted into the access and a contrast agent (X-ray dye) is injected to determine the cause of the blood flow problem. This running X-ray image is known as a fistulagram or angiogram. If stenosis or narrowing is identified, an angioplasty and or stent can be used to repair and improve blood flow in the graft or fistula.

Balloon Angioplasty

An angioplasty treats any narrowing or blockage of the vascular access. During the procedure, a balloon catheter is inserted through the graft or the fistula and carefully inflated to dilate the narrowed area. The balloon is subsequently removed.

Stent Placement/Stenting

This procedure is needed when balloon angioplasty alone is ineffective. Once the balloon is removed, a stent (small and flexible metallic mesh tube) is implanted to keep the graft or blood vessel open.

Fistula Maturation 

This is also referred to as Balloon Angioplasty Maturation Procedure (BAM). After a fistula is created in the arm, it needs to mature or dilate, which typically takes 4 to 6 weeks to be ready for dialysis. If the fistula matures slowly or dilates inadequately, a fistulagram is done to identify the underlying cause of the maturity delay.

If a narrowing is present, balloon angioplasty can be used to dilate the fistula, promoting maturation mechanically. The procedure can take few sessions spread out over 4 to 6 weeks to dilate the fistula to the right size for dialysis.  If the problem is caused by large branches taking flow away from the fistula and causing a delay in maturity, a coil is inserted into the branch to stop the flow (embolization). 


If your access stops flowing it means that it is completely blocked due to a clot and cannot be used for dialysis. To remove the clot, a procedure similar to angioplasty is performed to remove the blood clot and restore flow in your fistula/graft. Clot dissolving medicine may also be placed into the fistula or graft to dissolve the clots. After blood flow has been restored, a fistulagram is performed to determine the underlying cause of the clot.

Fistula Collateral Vein Ligation

After a fistula has been created in your arm, it is evaluated occasionally with an ultrasound examination. Some people may have one or more small vein branches that might drain blood away from the fistula. If this happens, the vein branch can be blocked off with a suture or coil to enable the fistula to develop into functional access for dialysis. 

Tunneled Dialysis Catheter Insertion 

A tunneled dialysis catheter is used for short term dialysis access. The dialysis catheter is inserted into one of the veins in the neck or groin and then tunneled under the skin to exit in either the upper chest or thigh. At the exit site, a small cuff sits under the skin to keep the catheter in place and prevent bacteria from entering the body. The catheter contains two lumens; one for carrying blood to the dialysis machine and the second one for taking blood back into the body once its cleansed. Both lumens are fitted with a cap that prevents blood leaks or entry of air into the blood.

Tunneled Catheter Exchange and Removal

This involves the replacement of a catheter for a different type or a new one due to a thrombotic or infectious complication. If a catheter has malfunctioned, an angioplasty may be performed to treat any underlying vessel blockage. Catheter removal is done when a catheter is no longer required.

Temporary Catheter Insertion 

A temporary dialysis catheter is inserted into a large vein to exchange blood during dialysis. These temporary catheters are only meant to be in place for few days.

Vein Mapping 

Mapping the arm veins helps achieve a higher arteriovenous fistula (AVF) rate and improved fistula success rate before a surgical creation for dialysis access. The procedure is painless and uses ultrasound or IV dye to view the veins in the arms or chest to help a vascular specialist plan the placement of a new fistula or graft. 

Minimally Invasive Fistula Creation

Also called endovascular fistula creation, our vascular specialists are trained and experienced to create a new AVF in upper arm without any surgery or surgical scars. This is performed via very specialized, state of the art devices inserted through needle sized holes in your blood vessels. Once done, you do not have any stitches and can go home the same day.

Peritoneal Catheter Insertion, Manipulation or Removal

A percutaneous peritoneal dialysis catheter is placed through the abdomen and into the peritoneum to perform a specialized kind of dialysis called peritoneal dialysis. The peritoneal catheter is removed if peritoneal dialysis is discontinued or in case of an infection. In case of an infection, we remove it immediately to prevent the infection from spreading elsewhere.

Inflow Banding Procedure for Steal Syndrome

Steal syndrome, or dialysis-associated steal syndrome (DASS) occurs when there is insufficient blood flow to the hand in the dialysis access due to the diversion of arterial blood from the hand to the fistula or graft.  Steal syndrome is treated by an inflow banding procedure (aka MILLER procedure). The procedure adjusts the access to its proper size to restore adequate blood flow to the dialysis hand using an angioplasty balloon. 

Access ultrasound

An ultrasound is used to examine whether your access is maturing or whether there is a problem with the access. 


Our board-certified experts at Carolina Vascular Care, are highly skilled and experienced at placing and treating different kinds of access for dialysis. Our specialists are friendly and compassionate with our patients and keep them comfortable during their vascular access treatment. Our dialysis access management is done in an outpatient setting.

Contact us today for more information about dialysis access procedures and request an appointment online. We are glad to help.