End Stage Renal Disease
Chronic kidney disease occurs when the kidneys gradually lose function over time. If this gets severe enough, the kidneys can fail – end stage renal disease. When this occurs, patients may require renal replacement therapy, such as hemodialysis or peritoneal dialysis. From helping to diagnose the causes of kidney injury with renal biopsy to placement of dialysis catheters to initiate hemodialysis, the Interventional Radiologists are able to help nephrologists (kidney doctors) and vascular surgeons prevent and treat end-stage renal disease.
Dialysis Access Planning
In many patients, it is best to create an arteriovenous fistula or graft for hemodialysis. In some patients, particularly those who have had these fistulas/grafts previously, surgeons find it helpful to obtain pictures of the arteries and/or veins for planning purposes. Pictures of the arteries are known as arteriograms. Pictures of the veins are known and venograms.
Upper/Lower Extremity Arteriogram
Under a mixture of ultrasound and x-ray guidance, a needle is advanced into an artery of the leg. A wire is advanced into the artery via the needle. The needle is exchanged over the wire for a catheter, which can be directed into the arteries of the arms or legs. Then, contrast is injected, and pictures of those arteries are obtained.
These procedures have a low risk of bleeding, infection, and damage to nearby organs. They can be performed on both inpatients and outpatients. Both should abstain from eating and drinking for 6 hours prior to the procedure so that they can receive relaxation medications (i.e. moderate sedation). Additionally, both are required to stay for several hours after the procedure to prevent bleeding at the arterial access site.
Upper/Lower Extremity Venogram
Similar to the arteriography above, under a mixture of ultrasound and x-ray guidance, a needle is advanced into the veins of the arm or leg. The needle is then exchanged over the wire for a catheter. Contrast is then injected via that catheter to obtain pictures of the veins.
These procedures have a very low risk of bleeding, infection, and damage to nearby organs. The procedure usually does not require relaxation medication so most patients are allowed to eat and drink before the procedure. They can be performed on both inpatients and outpatients, who usually return to their room/home quickly after the procedure is completed.
Dialysis Access Creation
Hemodialysis Catheter Placement
Catheters are placed using a combination of x-ray and ultrasound guidance. A small needle is advanced into the target vein. A wire is advanced through the needle through that vein, centrally. The needle is exchanged over the wire for the catheter, and then the wire is removed, leaving the catheter behind.
These procedures have a low risk of bleeding, infection, and damage to nearby organs. They can be performed on inpatients and outpatients. Inpatients can return to their room almost immediately after the procedure. Outpatients typically return home after the procedure.
Dialysis Access evaluation
Hemodialysis fistulas and grafts may stop working over time. If/when this happens, the patient may need to have their access evaluated and treated. This is typically done with a combination of evaluation of the graft during dialysis, physical exam, ultrasound, and if necessary, by placing a catheter in the fistula/graft and taking x-ray pictures of it while injecting contrast – a process known as a fistulagram/graftogram. If a narrowing/blockage is identified during the examination, it can be treated at the same time with a balloon and/or stent. IRs at HRA are proud to use the latest endovascular techniques and equipment, like covered stents and drug eluting balloons, to keep hemodialysis accesses working as long as possible.
These procedures have a moderate risk of bleeding, infection, and damage to nearby organs. They can be performed on both inpatients and outpatients. Both should abstain from eating and drinking for 6 hours prior to the procedure so that they can receive relaxation medications (i.e. moderate sedation). Additionally, both are required to stay for several hours after the procedure to prevent bleeding at the access site.
Renal Biopsy (Native and Transplant)
There are many possible causes for a kidney to lose function, and some of them can be treated. If a patient’s native or transplant kidney has started to lose function, it may help to obtain a small piece of the kidney to understand the underlying cause and direct treatment.
Using real-time image guidance (usually ultrasound and/or computed tomography), we can find the mass, use a tiny needle to numb overlying skin and soft tissues; then, we can advance a bigger needle into the mass and obtain pieces of the mass for pathologists to review.
The procedure usually has a mild to moderate risk of bleeding, infection, and damage to nearby organs. Depending on the location, most patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We perform this procedure for both inpatients and outpatients. Usually, 1-3 hours after the procedure, inpatients can return to their room and outpatients also usually can return home.
Doctors performing End Stage Renal Disease
Patrick Marcin, MD
Interventional Radiology (IR)