Hemodialysis is therapy a nephrologist uses to treat a patient's lack of adequate kidney function. when the kidneys fail, fluid and other body waste products accumulate as they cannot be eliminated in the urine. It is one mode of renal replacement therapy. You may be told that peritoneal dialysis, or renal transplantation or viable options for chronic renal failure, but if your nephrologist determines that you would need hemodialysis, a surgeon must create the access by which you could be dialyzed by.

An AVF (arteriovenous fistula) is where a surgeon connects a small artery to a vein that runs underneath your skin. Over time, the vein then grows larger from the pressure and influence of carrying arterial blood. The vein then can be punctured with needles through the skin so blood can be carried to the dialyzer. The radial artery and cephalic vein near your wrist is a common artery/vein pair that can support an AVF. A successful AVF must develop a vein that is near the skin, and can grow to high flow rates. If an arm's veins near the wrist cannot support an AVF, one can possibly be created near your elbow. This would then let the veins in the upper arm grow for use. A good AVF can take between 4 and 8 weeks to develop enough for good use. 70-80% of good AVFs are working at one year, and then out to five years for many patients. Because an AVF is natural artery and vein, infection is very inlikely.

At many vascular centers, a multidisciplinary approach maximizes useful life from hemodialysis access. Surgeons can sometimes suck clot out from a clotted access. Many of the discovered narrowing (or stenosis) can be dilated and enlarged with an angioplasty balloon. Other times, the graft material has just fallen apart, or the clot cannot be removed through a catheter. Then a surgical team can open up most grafts and clean them out under direct vision. If the vein that was supporting the AVG is too narrow, a short bypass to a new, larger vein can save use of the AVG. Sometimes, a whole new AVG in a new site has to be placed. Essentially all dialysis access procedures are done as outpatient procedures.