Patients with renal failure require hemodialysis via an arteriovenous fistula or a temporary tunneled catheter. AV fistula can be made with native vein or synthetic material such as Gore-Tex. Proper surveillance during dialysis and maintenance can increase the longevity of the AV fistula/graft. Tunneled dialysis catheters (permcath) can be a temporizing means of hemodialysis for those who require temporary dialysis or are awaiting AV fistula/graft maturity.
In advanced patients who no longer have AV fistula/graft options, tunneled catheter is the last remaining option of hemodialysis. Fistulograms (contrast study of fistula under fluoroscopic guidance) and insertion and change of tunneled catheters are performed with conscious sedation by an interventional radiologist in an outpatient setting. Angioplasty balloons and stents are used to reopen or dilate narrowed portion of the fistula to increase the lifespan of the fistula.