UNC Vascular Specialties Services

Dialysis Access

Patients whose kidneys don’t function adequately may undergo dialysis to take the place of certain waste-removal and electrolyte-balancing functions performed by normal kidneys. There are two types of kidney dialysis: Hemodialysis, in which the patient’s blood is pumped though a special toxin-removing filter before being returned to the body; and peritoneal dialysis, in which a special fluid is pumped into the peritoneal membrane of the abdomen, then later drained to remove toxins. In either case, patients must have permanent access points prepared by vascular specialists so dialysis can be repeatedly performed.

UNC offers the full spectrum of dialysis access procedures, including creating access points for both types of dialysis. For hemodialysis, UNC vascular specialists create the access point by surgically making a connection between an artery and vein just beneath the skin surface, a configuration known as a fistula. After a fistula is created, usually in the arm, the vein stretches and becomes stronger over time, allowing for more rapid blood flow, thus creating an ideal access point for repeated connection to a hemodialysis machine.

In occasional cases where the superficial veins are inadequate, our vascular specialists may indirectly connect the blood vessels by inserting a tubular piece of prosthetic material between the vein and artery, a procedure known as grafting or shunting.

Another access point procedure performed at UNC is implantation of the HeRO (hemodialysis reliable outflow) vascular assist device, which enables placement of a graft just below the skin in patients whose blood vessels traditionally haven’t been considered appropriate for graft placement. The procedure involves surgically connecting a piece of prosthetic tubing to an artery just above the elbow, then connecting the tubing to a tunneled flexible catheter positioned in the central venous system.

In addition, our vascular specialists provide assessment and intervention for access-point fistulas and grafts that have become dysfunctional over time, a common risk usually due to internal narrowing or blockage (stenosis). These intervention procedures are typically performed in the angiography suite at UNC, located right next to the Dialysis Access Clinic.


William Marston, MD
Mark Farber, MD
Peter Ford, MD
Joseph Fulton, MD
Raghuveer Vallabhaneni, MD

Referring Physicians

Open Access