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Arteriovenous Fistula Creation

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Arteriovenous Fistula Creation: Enhancing Dialysis Access and Patient Well-being

For individuals with end-stage renal disease (ESRD) who require long-term dialysis, the creation of an arteriovenous fistula (AVF) is a critical step in establishing reliable and efficient vascular access. An AVF is a surgically created connection between an artery and a vein, typically in the forearm or upper arm. Let’s explore the importance of AVF creation, its benefits, and the process involved.

Why is AVF Creation Important?

AVF creation plays a vital role in hemodialysis, a life-sustaining treatment for individuals with ESRD. During hemodialysis, blood is filtered and cleansed by a dialysis machine, and reliable vascular access is essential to facilitate the movement of blood to and from the dialysis machine. AVFs are considered the preferred form of vascular access due to their longevity, lower risk of complications, and improved dialysis outcomes compared to other access options such as arteriovenous grafts or central venous catheters.

Benefits of AVF Creation:
Improved Long-Term Vascular Access:

AVFs have the potential to provide long-lasting access for dialysis, reducing the need for repeated procedures and minimizing the risk of infection or other complications associated with temporary access options.

Increased Blood Flow and Dialysis Efficiency:

By connecting an artery to a vein, AVFs create a direct pathway for blood flow. This increased blood flow allows for efficient dialysis by facilitating the removal of waste products and excess fluid from the body during each dialysis session.

Lower Risk of Infection and Thrombosis:

AVFs have a lower risk of infection and clot formation compared to other access methods. The natural connection created between the artery and vein promotes better blood flow and reduces the likelihood of complications such as infection or blockages.

Preservation of Central Veins:

AVFs help preserve central veins, such as the subclavian or jugular veins, which may be necessary for future access options if AVF complications arise or if the AVF is no longer viable.

The AVF Creation Process:

The creation of an AVF involves a surgical procedure that is typically performed by a vascular surgeon. The process generally includes the following steps:

Preoperative Evaluation:

Before AVF creation, the surgeon assesses the patient’s vascular anatomy and determines the most suitable site for the fistula. Factors such as the diameter and quality of the veins and arteries are considered.

Surgical Procedure:

The surgeon makes an incision to access the artery and vein chosen for the AVF. The artery is dissected, and a segment of the vein is isolated. The artery and vein are then connected to create the fistula, allowing blood to flow from the artery into the vein.

Postoperative Care and Maturation:

After the surgery, the AVF requires time to “mature” and develop the necessary blood flow. This maturation process typically takes several weeks to months. During this time, the vein gradually enlarges, becoming suitable for dialysis needle insertion.

Monitoring and Maintenance:

Regular follow-up visits with the healthcare team are essential to monitor the AVF’s functionality and detect any potential issues early on. The patient is educated on proper care and maintenance of the AVF to minimize complications and maximize its longevity.

Arteriovenous fistula creation is a crucial step in establishing reliable vascular access for individuals requiring hemodialysis. By providing long-term access, improving dialysis efficiency, and reducing the risk of complications, AVFs contribute significantly to the well-being and quality of life of patients with ESRD.

The Joint Commission

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The Joint Commission Certification

The Joint Commission, also known as TJC, is an independent, non-profit organization in the United States that accredits and certifies healthcare organizations and programs. It was founded in 1951 and is recognized as a leader in setting quality and safety standards for healthcare.

The goal of The Joint Commission:

The primary goal of The Joint Commission is to improve the quality and safety of patient care. They achieve this by establishing rigorous standards and conducting thorough evaluations of healthcare organizations to ensure compliance. Accreditation by The Joint Commission is voluntary but highly valued and widely recognized as a mark of quality in the healthcare industry.

The accreditation process:

The accreditation process involves an in-depth review of various aspects of an organization’s operations, including patient care, infection control, medication management, leadership, and performance improvement. Surveyors from The Joint Commission visit healthcare facilities to assess compliance with the standards. If an organization meets the standards, they are awarded accreditation, which is typically valid for a specific period.

The Joint Commission certification:

In addition to accreditation, The Joint Commission offers various certification programs for specific areas of healthcare, such as disease-specific care, primary stroke centers, and advanced certification in healthcare quality.

The Joint Commission & Patient Saftey:

The Joint Commission plays a crucial role in promoting patient safety and quality improvement in healthcare organizations. Their standards and accreditation process help organizations identify areas for improvement, implement evidence-based practices, and continuously enhance the quality of care provided to patients.

It’s important to note that while The Joint Commission sets standards and evaluates healthcare organizations, they do not have regulatory authority. Their focus is on voluntary accreditation and continuous improvement rather than enforcing compliance through legal means.

Western Vascular Institute is a Joint Commission Accredited vascular-surgery-center garnering the gold seal of approval. These certifications demonstrate a higher level of expertise and specialization in particular areas of care.

Understanding Deep Vein Thrombosis (DVT)

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Symptoms:

can occur without warning signs
Also felt as discomfort in the affected area including Swelling and pain the affected leg. Additionally, redness and warmth along the vein where the clot is found.

Causes


Coagulation of blood is an important process that helps to prevent excessive bleeding during injury. However, in the absence of Injury, when the blood is not flowing properly or if it pools in the veins the platelets in the blood that help with coagulation can stick together and cause it to clot.

a. Inactivity- During a long flight or drive
b. Damage to a vein
c. Cancer or other diseases that cause your blood to clot more easily
d. Medications
e. Hormones


Risk Factors

a. Age
b. Obesity
c. Pregnancy
d. Family History of DVT
e. Having a catheter placed in a vein
f. Deep vein injury
g. Smoking

Diagnosis


Your vascular surgeon will ask questions about your symptoms and medical history as well as performing a thorough physical examination.

a. Duplex ultrasound to check the flow of blood in the area of the perceived clot. A Venograph can also be done by injecting a contrast dye into the vein under x-ray to see where the dye is allowed to pass through. The X-ray will show a mapping of your veins and show the area where the contrast dye was unable to pass through. Although DVT’s can generally be diagnosed by duplex ultrasound, venography is another option Western Vascular Institute has available to confirm the diagnosis.

Treatments


Most often a Deep Vein Thrombosis or DVT can be treated by a medication known as blood thinners or anticoagulants. These medications help prevent the blood from clotting and over time reduce the size and consistency of the clot.

Staying Healthy


Maintain good overall health including a healthy diet and staying physically active will help reduce the risk of a DVT. It is likewise important to maintain a healthy weight and make sure to follow up with your vascular surgeon to discuss the possibility of long-term blood thinner medications.

https://www.westernvascular.com/vein-center/deep-vein-thrombosis/

https://vascular.org/patients/vascular-conditions/deep-vein-thrombosis

 

Vascular Ultrasound

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Vascular ultrasound

Vascular ultrasound, also known as duplex ultrasonography or Doppler ultrasound, is a non-invasive imaging technique used to evaluate blood vessels and blood flow in the body.

During this study, a small handheld device called a transducer is used to emit high-frequency sound waves into the body. These sound waves bounce back off the blood vessels and are detected by the transducer, which converts them into images that can be viewed on a monitor.

Vascular ultrasound is commonly used to diagnose and monitor various vascular conditions, including:

 

Peripheral artery disease (PAD):

Evaluating blood flow and detecting blockages or narrowing in the arteries of the legs, arms, or neck.

Deep vein thrombosis (DVT):

Detecting blood clots in the deep veins, usually in the legs.

Carotid artery disease:

Assessing the carotid arteries in the neck to detect plaques or other abnormalities that may increase the risk of stroke.

Abdominal aortic aneurysm (AAA):

Evaluating the aorta in the abdomen for the presence of an abnormal bulge or enlargement that could potentially rupture.

Venous insufficiency:

Assessing the veins and valves in the legs to identify valve dysfunction or venous reflux, which can lead to conditions like varicose veins.

Vascular ultrasound is a safe and painless procedure that does not involve radiation. It provides real-time images and can be used to measure blood flow velocity and direction using the Doppler effect, which allows the assessment of blood flow characteristics such as speed and turbulence.

The results of a vascular ultrasound can help vascular surgeons make accurate diagnoses, develop appropriate treatment plans, and monitor the effectiveness of interventions over time.

What is Atherosclerosis?

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Atherosclerosis – is a disease process that leads to the hardening or clogging of arteries. The build-up over time of substances such as fat, cholesterol, & calcium, collectively called plaque, narrows the artery and restricts the amount of blood able to pass through the arteries, and provides oxygen-rich blood to the body. This stenosis or narrowing of the artery can lead to serious problems such as stroke, amputation, heart attack, and death.

 

Introducing Dr. David J. Paolini

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Dr. David J. Paolini vascular surgeon in Arizona.
Dr. David J. Paolini Vascular Surgeon with Western Vascular Institute. Board Certified Vascular Surgeon

Dr. David Paolini is a Vascular Surgeon with over 15 years of Vascular Surgery experience.  Dr. Paolini recently joined Western Vascular Institute as one of our acclaimed vascular surgeons from the Jobst vascular center in Toledo, Ohio. Dr. Paolini has had a passion for medicine and physics from a young age, feeling that Vascular Surgery is the perfect combination of the two scientific areas. Dr. Paolini completed his medical school training from Temple University (One of the best Medical Schools in the united states) in 1999 and after that moved to New Mexico to begin his residency at the University of New Mexico Health Sciences Center Department of Surgery. After completing a 5-year surgical residency Dr. Paolini then moved to Toledo, Ohio to complete a Vascular Surgery specific fellowship at the prestigious Jobst Vascular Center. Dr. Paolini quickly gained accolades as one of the most innovative and competent vascular surgeons in the area as well as being heavily invested in Vascular Surgery research and publications. Dr. Paolini’s care philosophy is “ to take care of patients like you would want your kids’ taken care of ”. As a father of two wonderful children and supported by his beautiful wife Dr. Paolini is poised to join the ranks of the great caring vascular surgeons here at Western Vascular Institute. Dr. Paolini’s previous patients have described dr. Paolini as being kind, compassionate, & honest. We are excited to have Dr. Paolini as part Western Vascular Institute. Dr. Paolini is now accepting new patients in the Mesa and Payson office locations. For an appointment with Dr. Paolini please contact one of our new patient coordinators at (480) 668-5000 ext. 332