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Yale-New Haven Hospital (YNHH) offers services that help assure that a patient has a successful dialysis treatment, either through peripheral access or a catheter. Our goal is to maintain good access for all patients. Despite advancements in technology, the weak link in the dialysis process is still vascular access. Sometimes, patients have a stenosis, or narrowing of the vein, that can make access difficult.
The team
Our nephrologists are experts at monitoring dialysis access, having researched and performed the latest advancements. Once a clinically significant stenosis is identified, most patients' first line of therapy is endovascular treatment.
Technological advancements used by YNHH physicians to prolong the patency of the hemodialysis access include:
Phamaco-mechanical methods
When the graft or fistula fails, YNHH interventionalists remove the thrombus, using mechanical or pharmaco-mechanical methods. The underlying anatomic cause of the access failure is then treated with balloon angioplasty, and sometimes stents, in an effort to prolong access.
Catheter assess
When peripheral access is no longer possible, catheter access is often the only option. YNHH physicians perform problem catheter access, including reopening of occluded veins and novel access solutions such as translumbar and transhepatic routes. They utilize advanced imaging techniques to guide puncture of the vein and subsequent placement of the device.
Clinical trials
YNHH recently participated in a clinical trial on the use of a new heparin-coated Gore-Tex stent at the site of vessel stenosis.
Download the Services and Outcomes Guide (PDF).