Dialysis is short for hemodialysis, which is a blood treatment procedure for patients with chronic kidney failure. The kidneys filter waste from the blood, but when the kidneys fail, dialysis is necessary to take over that filtering. Dialysis is necessary when 85 to 90% of kidney function is lost. During dialysis, blood is removed from a vein and is circulated through a filtering machine before being returned to the body.

 

Vascular Access for Dialysis
Veins tend to have weak blood flow that is not durable enough to provide for the necessary output of dialysis. Because of this, a doctor will often surgically connect a vein to a nearby artery to strengthen the vein and allow for heavier circulation. The increased strength allows long-term dialysis to be possible.

 

Types of Vascular Access
The needs of dialysis patients vary, and therefore there are three main types of vascular access for treatment that may be recommended:

  • Arteriovenous Fistula
    An arteriovenous, or AV fistula is the surgical connection of an artery to a vein. The fistula is created during a minor outpatient procedure under local anesthesia. Fistulas typically take some time to mature, but they are usually the preferred method due to less risk of complications over artificial grafts and catheters and higher durability.
  • Arteriovenous Grafts
    If a patient has small veins that will not properly develop into a fistula, they will typically require a synthetic tube graft to make the connection between the artery and vein. This graft can be used for needle access during hemodialysis. Unlike fistulas, a graft does not need ample time to develop, and therefore is a better option when access is needed more urgently.
  • Venous Catheters for Temporary Access
    For quickly progressing kidney disease, patients may need a venous catheter for temporary but immediate access. Catheters are not ideal for permanent access.

 

Complications of Vascular Access
As with any procedure or treatment, there are risks. Most often the complications are associated with venous catheters. Risks associated with all three types of vascular access, although uncommon, may include:

● Infection
● Low circulation
● Blood clots

Sclerotherapy is a minimally invasive procedure that treats varicose and spider veins, most often in the legs. The injection of a solvent into the veins causes the vessels to collapse and restore proper blood flow.

 

Reasons for Spider Vein Treatment
Those who are affected by varicose veins, either for cosmetic reasons or because of painful/dangerous symptoms due to the diseased veins, can undergo sclerotherapy. Some symptoms include:

● Swelling and redness at the site
● Cramping of legs
● Scaly, discolored, and dry skin at the site
● Discomfort after standing or sitting for long periods
● Pain, burning, or aching in feet and legs

 

The Sclerotherapy Procedure
The procedure includes the injection of saline and a sclerosant into the affected veins. These substances will cause the veins to collapse and eventually be reabsorbed into the body, so that other healthier veins can take over and provide proper circulation. The procedure is proven to be safe and effective, and can be performed as an outpatient procedure in less than an hour. There is little to no discomfort during the process, even without anesthesia. Typically, only a mild burning sensation is reported.

 

Risks of Sclerotherapy
Although sclerotherapy is a safe and successful procedure, there are certain possible risks that may include:

● Inflammation
● Bruising and discoloration (temporary)
● Blood clots
● Air bubbles in bloodstream
● Nerve damage
● Allergic reaction to sclerosant

 

Recovery from Sclerotherapy
Patients can return home the same day and most can return to work and regular activities the next day. Exercise and strenuous activities should be avoided for about a week or two. For about a week after the procedure, compression bandages should be worn. Some improvement might be seen immediately, but full results may take about a month to be apparent. It is recommended that patients maintain healthy lifestyles by controlling weight and regularly exercising to promote vascular health and preserve the effects of their sclerotherapy.

Endovenous laser therapy, or EVLT, is a minimally invasive procedure used to treat varicose veins. EVLT has both cosmetic and health benefits and is considered safe, quick, and effective. The outpatient procedure takes less than an hour and can be performed in the doctor’s office. EVLT provides instant relief of symptoms without scarring or a long recovery, and is FDA approved with a 98% success rate.

 

The EVLT Procedure
During the procedure, the physician will mark the affected veins and use an antiseptic and local anesthetic. A laser probe is then inserted into the vein and positioned properly, confirmed with imaging from and ultrasound. The laser energy targets the damages veins and causes them to collapse so that blood can no longer flow through. Healthier vessels will take over blood flow that the diseases veins were previously circulating. The probe is removed and compression bandages are applied.

 

The Risks of an EVLT
Although EVLTs are considered safe, there are certain risks associated with any surgical procedure. Some risks may include:

● Numbness
● Vein inflammation
● Deep vein thrombosis
● Infection
● Ineffectiveness of the procedure
● A drawing sensation

 

Recovery from EVLT
Most patients experience temporary tightness in the legs and mild bruising, but these symptoms will subside within a few days. Patients can go home immediately after the procedure and can resume normal activities the same day. Strenuous activities should be avoided for a period of time suggested by the physician. Results are typically visible immediately. Because of the fast recovery and pain-free results, most patients enjoy more attractive legs and are satisfied with the procedure. EVLT is becoming the new standard treatment for varicose veins.

Microphlebectomy, or stab phlebectomy is a minimally invasive procedure that treats varicose veins. Microphlebectomy is performed when the veins are too large for sclerotherapy but too small for laser ablation. The procedure uses small punctures that remove damaged veins and divert blood flow to health ones.

 

The Procedure
The procedure will take place in your doctor’s office under local anesthetic. A microphlebectomy usually has a very short recovery time and patients can typically return to regular activities the same day, but should avoid strenuous activity for a week. Patients usually are required to wear compression bandages for the week following the procedure to minimize bleeding and swelling.

 

Risk of Microphlebectomy
Although this procedure is considered safe, there are certain risks associated with any surgical procedure. There is a possibility of bruising and discomfort for a few days, and in rare instances, a skin nerve injury.

Deep vein thrombosis, or DVT, is a condition in which a blood clot, or thrombus, occurs in a vein that is deep in the body. Most commonly DVT occurs in the legs.

 

Causes of DVT
Most patients with DVT are over the age of 60, but the condition can occur at any age. Some causes that result in DVT may include:

● Long periods of bedrest or inactivity
● Pressure from pregnancy or obesity
● Inherited conditions
● Vein damage
● Reactions to medication
● Hormone replacement or birth control
● Smoking
● Certain cancer treatments

 

Symptoms of DVT
About half of all DVT cases are present without symptoms. If symptoms do occur, they may include:

● Pain at the site
● Swelling in the legs, ankles, and feet
● Swelling along the vein
● Redness or discoloration of the skin
● Warmth to the touch

 

Diagnosis of DVT
Your physician will check your blood pressure, breathing, and heart sounds and do a thorough physical examination of the legs. Some other diagnostic tests for DVT may include:

● Ultrasound
● Venography
● CT scan
● MRI scan
● D-dimer test
● Blood tests

 

Treatment of DVT
Most treatments are focused on preventing the thrombus from growing in size and the development of another clot. Treatments will also focus on preventing an embolism, which occurs when a clot of segment of plaque breaks off and travels elsewhere in the body and creates a dangerous blockage. This can occur in the lungs, heart, or brain, and therefore can cause life-threatening strokes or heart attacks. The course of treatment for DVT will likely be a combination of compression and medication.

 

Compression Stockings
Special elastic stockings that put pressure on the veins will be prescribed to keep the blood from clotting and pooling. In less severe cases, these stockings may keep the condition under control on their own.

 

Anticoagulants
Blood thinners are medications which cause easier circulation. Heparin (injection or intravenous tube) and warfarin (pill form) are common anticoagulants.

 

Thrombin Inhibitors
These medications interfere with the blood clotting process by inhibiting the enzyme thrombin.

 

Vena Cava Filter
This filter is placed inside the vein that carries blood from the lower half of the body back to the heart called the vena cava. The filter prevents a pulmonary embolism by catching blood clots before they can get to the lungs.

 

Symptoms of DVT
Some symptoms of an embolism may include:

● Sudden shortness of breath
● Sharp chest pain
● Pain worsened by deep breathing or coughing
● Dizziness
● Cough with pink, foamy mucus

 

Prevention of DVT
Improvement of vascular health will lessen the risk or slow the progression of DVT. Some methods of improving vascular health are:

● Losing weight
● Quitting smoking
● Managing blood pressure
● Regular exercise
● Not sitting or standing in one place for too long

Endovenous Radiofrequency Ablation, or RFA, is a minimally invasive treatment of varicose veins. As blood pools in the veins, the walls of the vessels become damaged and appear raised and are visibly twisted. Varicose veins can be a cosmetic problem, but they can also become dangerous and painful.

 

Reasons for RFA
Varicose veins result from venous reflux, or the backward flow of blood in the veins. Symptoms may include:

● Feeling of heaviness in legs
● Bleeding, ulceration, and discoloration along the veins
● Pain while sitting or standing
● Swelling and distension along the veins

Patients will small varicose veins called spider veins may not be candidates for RFA and sclerotherapy may be a better option.

 

Benefits of RFA
Some benefits of an RFA include:

● Small incisions with no scars or sutures
● Little to no pain or discomfort
● Short recovery time
● Immediate relief
● Successful removal of damages vessels

 

The RFA Procedure
The skin will be numbed with a local anesthetic and a radiofrequency catheter is inserted in the vein. Ultrasounds images confirm proper placement, and the vein is exposed to the RF energy to seal off the vein. Blood flow will be taken over by healthier veins and proper circulation will be restored.

 

Risks of RFA
While RFAs typically have low incidence of complications and are considered safe, all surgical procedures have associated risks. These risks may include:

● Thrombophlebitis
● Deep vein thrombosis
● Nerve damage
● Skin burns
● Bruising
● Infection

 

Recovery from RFA
Patients can return to regular activities the very same day after their procedure, but should avoid strenuous activity for a few weeks. If pain occurs, it is usually mild and only occurs for a few days. Compression stockings should be worn for about a week after the procedure to prevent swelling and bruising. Making healthy lifestyle changes will prevent future vascular damage and ensure the longevity of the RFA’s results.

 

Ultrasounds
Ultrasounds at East Bay Cardiovascular and Thoracic Associates are done:
Danville: Monday & Wednesday 9:00am – 5:00pm
Concord: Monday, Tuesday, Thursday, & Friday 9:00am – 5:00pm

 

Types of Ultrasounds Offered

● Carotid
● Peripheral Arterial Duplex
● Venous Duplex
● Abdominal/Mesenteric
● Vein mapping
● Exercise Ankle-brachial index (ABI)