The surgeons at the Division of Vascular and Endovascular Surgery at Mount Sinai Beth Israel offer minimally invasive endovascular and open surgery procedures to patients suffering from kidney (renal) and intestinal (mesenteric) artery disease. We also treat patients who are dealing with kidney failure and need dialysis access.
The arteries (vessels carrying oxygen-rich blood away from the heart to all parts of the body) or veins (blood vessels bringing blood back to the heart) can develop waxy deposits on their walls called plaque, that narrow or block the vessels. When a blood vessel becomes narrowed or blocked, less blood reaches parts of the body. This can cause serious problems if it occurs in arteries bringing blood to the brain, heart, kidneys or legs. The loss of blood to the legs can cause limb loss or death.
When is it needed? Balloon angioplasty uses a tiny inflatable balloon to open up the artery, narrowed by plaque, to improve blood flow.
What happens? Through a small incision in the groin, a catheter (long plastic tube) carrying a tiny balloon carried on its tip, is guided to the blocked artery. When the balloon inflates, it pushes plaque back against the walls of the artery, expanding the diameter inside the blood vessel and increasing blood flow.
When is it needed? The arteries can have narrowing or blockages due to plaque or blood clots. To keep the blood flowing, a tiny metal tube called a stent is guided to the blockage, then left behind to keep the vessel open.
What happens? Through a small incision in the groin, a catheter (long plastic tube) guides the stent to the problem area, where it remains permanently. The stent props open the artery, preventing it from collapsing or being closed again by plaque.
When is it needed? Arteries are normally smooth on the inside. But over time, a sticky substance called plaque can build up in the walls of the arteries. As more plaque builds up, the arteries can narrow and stiffen. This process is called atherosclerosis, commonly known as hardening of the arteries. As the process continues, less blood flows through the arteries, and the body is no longer receives the oxygen and nutrients it needs. Surgical bypass corrects this condition by creating an alternate route for the flow of blood–a literal "bypass" around the section of artery that is blocked.
What happens? The surgeon creates a new pathway for blood flow by inserting a new vessel called a graft. A graft can be created from a portion of one of the patient's own veins or it can be a synthetic tube. In either case, the new vessel attaches to the affected artery above and below the blockage, letting blood pass around it.
When is it needed? When a person's kidneys fail, also known as renal failure, they may need dialysis treatments to stay alive. Dialysis is a life-saving procedure that cleans the blood of toxins and removes excess fluid from the body. But first, the filtering system needs "access" to the person's bloodstream.
Through this access (or entryway), a portion of a person's blood is removed and circulates through the dialysis machine, which removes impurities and regulates fluid and chemical balances. The purified blood then returns to the person, again through the dialysis access.
What happens? There are four ways to create dialysis access. These access options lie completely beneath the skin, and are created through a minor surgical procedure.
A catheter, a long soft tube, is inserted in the large vein either in the neck or under the collarbone. This is usually a short-term choice, because the catheter gets infected easily, and causes stenosis (narrowing).
An arterivenous graft is created by connecting a vein to an artery with a soft plastic tube (graft). Dialysis is performed by placing two needles in the graft.
An arterivenous fistula is considered an excellent long-term option. The surgeon creates the fistula–which is a surgically created passageway–by connecting an artery directly to a vein. Once the connection (fistula) gets bigger and stronger (matures), it can be used for dialysis for years with almost no risk of infection. However, not every patient is a good candidate for this type of access.
Peritoneal dialysis (PD) is another option for patients who can't tolerate the rapid changes of fluid balance associated with hemodialysis. During hemodialysis, your blood is pumped into a machine to be filtered and then returned to your body (abdominal cavity). A catheter is surgically inserted into the abdomen on a permanent basis allowing the blood vessels in the abdominal lining (peritoneum) to fill in for the kidneys, with the help of a fluid (dialysate) that flows into and out of the peritoneal space. Risks associated with peritoneal dialysis include infections, weight gain and hernia.
Our vascular surgeons are experts at evaluating which type of dialysis access is best for each patient, based on their physical condition, anatomy and lifestyle. Our surgeons continually monitor the access point to make sure it continues to work properly. In some cases, maintaining the access involves the use of minimally invasive techniques such as:
- Clot-dissolving medication
- Stenting (propping open the access blood vessel)
- Ballooning (enlarging) of the arteries and veins