Easing Access: An Innovative Approach for Dialysis Patients

Chronic kidney disease affects more than one in seven U.S. adults — an estimated 37 million Americans — and many don’t know it, according to the National Institutes of Health. In its early stages, kidney disease has few symptoms. Left untreated, however, the disease can progress; people whose kidneys no longer function may require hemodialysis to stay alive.

For patients who require dialysis, which is the external filtering of the blood through an artificial kidney, access to their vascular system is required in order to hook up the machine. Several choices exist for this, but the preferred option, when possible, is a fistula, which is created by joining an artery and a vein in the arm to create a “closed circuit” for blood removal and return.

Miguel Lopez-Viego, M.D., vascular surgeon at Baptist Health Bethesda Hospital East and Bethesda Hospital West.

Until recently, this fistula could be created only with open surgery. However, the fellowship-trained vascular surgeons at Baptist Health Bethesda Hospital East and Bethesda Hospital West offer a less invasive option, using an innovative device called the WavelinQ.

“We have a lot of experience with this,” says Miguel Lopez-Viego, M.D. “It’s a very interesting device that can be inserted percutaneously, through the skin. Our center has done more procedures using this device than anywhere in the world.” 

Understanding Kidney Function

Most people have two kidneys, each about the size of an adult fist, located on either side of the spine just below the rib cage. Although they are small, the kidneys perform many vital functions.

Kidneys filter the blood, help remove waste and excess fluid, and assist in regulating blood pressure, red blood cell production, hormones and the amount of certain nutrients in the body, such as calcium and potassium.

Blood enters the kidneys through an artery from the heart and is cleaned by passing through millions of tiny filters. Waste material is diverted to the bladder as urine, and newly cleaned blood is returned to the bloodstream by way of veins.

Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history.

Why Dialysis?

When you have advanced kidney disease, your kidneys can no longer keep up with your body’s need to remove waste and water. Once the kidneys have only10-15 percent of normal function, dialysis treatments are necessary to sustain life.

Hemodialysis is a procedure in which a machine and artificial kidney, or a dialyzer, are used to clean the blood. To get your blood into the dialyzer, the doctor makes an access, or entrance, into your blood vessels. Your blood goes to the machine through a tube, gets cleaned, and is returned to you through another tube.

A fistula is considered the first choice for access because it generally lasts longer and has fewer problems such as infections and clotting, Dr. Lopez-Viego explains.

A Less Invasive Option

The WavelinQ option offered by Bethesda Hospital vascular specialists uses a completely endovascular approach with two thin, flexible, magnetic catheters and a burst of radiofrequency to create a fistula in vessels that are not traditionally used to create fistulas during open surgery. The small needle punctures heal quickly with minimal need for wound care. There are no stitches and little to no scarring.

Dr. Lopez-Viego says use of this innovative technology is just one example of the vascular surgery team’s dedication to serving the community with excellence, using less invasive approaches when possible.

“A lot of novel procedures have come out of our program,” Dr. Lopez-Viego says. “Our goal is always to find the most successful solution for patients while taking into consideration their comfort and individual needs.”