Blocking, swelling, and becoming numb everyday, AV fistula problem that repeats over and over. We will be your ‘trustworthy companion’ so that you won’t be alone in the endless fight that will follow you for lifetime. MINT hospital Vascular Center achieves fast recovery, precise treatment, and minimal side effect with diverse approach from in and out of AV fistula,.

• AV fistula recanalization
  procedure

  • Stent insertion
  • Balloon angioplasty
  • Thrombectomy

• HYBRID CARE
  AV fistula
  hybrid treatment

  
  

  • Procedure
  • Surgery

• Dialysis access surgery

  • AVF (Autologous AV fistula)
  • AVG (Artificial dialysis graft)

  Corrective surgery

  • Av fistula reduction
  • Vein superficialization
  • Dialysis streamline surgery
  • Pseudoaneurysm resection
  • peripheral vessel ligation

• 

  What is
  AV fistula recanalization ?

  It can treat conditions like stenosis, occlusion, thrombosis, and calcification that induces circulatory disorder in AV fistula. It recanalizes narrowed or occluded fistula by inserting fine medical device (catheter) intravascularly. It is also called ‘Percutaneous transluminal angioplasty (PTA)’ or ‘percutaneous recanalization’ It is performed by intervention radiologist.

• 

  Expansion and speed

  State-of-the-art medical device is attached to the catheter depending on stenosis in the fistula to conduct more detailed
  treatments like stent insertion, balloon angioplasty, and thrombectomy. Recanalization has its advantage in that it can immediately treat the problem in any segments, from AV fistula to vein entering the heart, and dialysis is available right after the procedure

Procedure process

• 

  Insertion at the occlusion

• 

  Destruction of the occlusion

• 

  Recirculation

After inserting balloon catheter at the section of fistula occluded by thrombus, balloon is inflated to expand the causative fistula. As the occluded fistula is recanalized, the blood circulation returns to normal.

• Local anesthesia ▶
  Small incision of
  1.5mm in the skin ▶
  Guide wire insertion
• Insertion of catheter
  with balloon, drug,
  or stent (metal net) based
  on the purpose
  of the treatment
• Contrast injection
  with catheter ▶
  Angiographic X-ray
  imaging in real time
• Catheter approaches
  the lesion via blood
  vessels to treat stenosis,
  occlusion, thrombosis,
  and calcification
• Removal of
  surgical device ▶
  Immediate dialysis

Treatment outcome

AV fistula is underdeveloped due to stenosis before the treatment (shown in arrow), making only artery visible and leaving the vein occluded.
After treatment, the blood flow returns to normal and vein is visible

What is dialysis access surgery?

It connects artery and vein directly or via artificial graft, creating a new dialysis channel (access).

After the surgery, AV fistula that has matured for 1~3 months can be used without problem only after satisfying the following conditions

Good AV fistula must flow in straight line with adequate thickness at adequate depth.

However, if the problems like

Once ‘aneurysm' that enlarges AV fistula and convolute its path, blood flow into the fistula becomes too excessive,

which causes

If such complication arises, it also affects dialysis, so reduction is performed to modify the fistula into more adequate size and straight passage.

• AV fistula Used longer and
  healthier
• Cardiac failure
  prevention Minimal cardiac
  stress
• Without hemodialytic
  catheter Sustaining
  original AV fistula

Treatment result

Surgery process

• Vascular condition
  check

  
  

  • AV fistula ultrasound
  • Angiograph

• Surgery plan and
  preparation

  
  

  • Pre-operation test and preparation

• Operation

  
  

  • Local anesthesia and sedation anesthesia
  • Problematic fistula resection and suture

• Recovery

  
  

  • disinfection in surgical site for next 2~3 weeks
  • Hemodialysis possible with the treated site after 3~4 weeks.

After reduction, the pressure in AV fistula decreases and the blood flow returns to normal, decreasing the stress to heart.
In long-term, stenosis in central vein decreases and AV fistula is kept for long period.

AV fistula goes through hemostasis process where the puncture by needle persists, then the surrounding tissue slowly blocks the puncture.
The bleeding may not stop if the puncture is made repeatedly on one or two areas and the vascular wall becomes thinner or if complication arises during the recovery process after the surgery.

The blood that leaks from the area where bleeding is not completely sealed off may collect in subcutaneous fat layer, form a sac, and bulge. It is called ‘psuedoaneurysm’.

Pseudoaneurysm is common in AV fistula and it also often can occur autologous AV fistula located deep inside the flesh.
If pseudoaneurysm gets larger, it may cause various complications like sepsis, skin defect (artificial graft fistula), thrombosis, thrombophlebitis, skin infection, vascular rupture (autologous fistula)

Commonly, surgery is performed when there is a problem in vascular wall along with psuedoaneurysm 1cm or larger or when there is thrombus.

Treatment result

Well-made AV fistula must satisfy ‘3 conditions’ of blood flow, size, and depth.
Particularly, ideal depth is 5~6 mm underneath the skin.
If the fistula is located too deep, the needle can’t puncture the fistula easily and consequently puncture one or two site that is easy to puncture, which increases the risk of pseudoaneurysm.
The reason the veins are located deep is because the veins are hidden inside thick fat layer.
Therefore, vein superficialization is commonly performed with ‘venous lifting (Lifting surgery)’ and ‘Fat layer removal’.

In MINT hospital, we perform hemodialysis access surgery and vein superficialization at the same time for patient’s convenience.

Treatment result

• Recanalization and
  surgery all at once Faster and
  more reasonable!
• All the problems treated
  at once Greater
  efficiency!
• Inside and outside
  of AV fistula at the same time Better
  results!

Treatment result