Dialysis Maintenance & Access

Dialysis Maintenance

For the millions of people in the United States with non-functioning or poorly-functioning kidneys, dialysis can be a life-saving procedure. Quite often, though, the catheters, tubes, fistulas, or shunts used to deliver treatment can malfunction, putting the patient at risk.

The UNC Heart and Vascular Center offers same-day intervention for critical dialysis problems, and within 24 hours for non-emergency situations. All of the radiology physicians in the UNC Heart and Vascular Center are board-certified and specialize in interventional procedures.

Patients are admitted into a modern surgical center with a large waiting room and individual recovery areas. Every aspect of dialysis maintenance is offered, including on-site dialysis once the situation is corrected. For example, if a hemodialysis catheter becomes blocked or infected, it will be exchanged and the reason for the problem will be investigated. Procedures are performed with x-ray and ultrasound guidance to ensure the utmost in procedure success and patient safety.

If the situation requires further intervention, the UNC Heart and Vascular Center will refer the patient to specialists from nephrology, cardiology, surgery or other departments readily accessible on the UNC Health Care campus.

Most kidney disease is caused by diabetes, high blood pressure, or other insults to the kidneys.


Charles Burke, MD
Joe Stavas, MD
Robert Dixon, MD
Ari Isaacson, MD

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

Contact Us

Call the Heart & Vascular Center referral line at 866-862-4327 to find specialists, make an appointment or learn more about preventing heart disease.

Open Access is a new physician referral service, created by the UNC Center for Heart & Vascular Care, which coordinates all admissions and transfers through a single phone call and guarantees immediate acceptance for patients. Please contact us to learn more or call 866-862-4327.

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