Memories and Fistulas

September 8, 2015 by Vascular Experts

My Grandmother was an amazing woman. Born and raised in southern Rhode Island she was the classic example of New England grit and vigor. She was always on the go, doing something. She loved the beach and going swimming, even when the waves chase away people much younger than her. She was a champion duck pin bowler at in her 60s. She was a dangerous person to play cards with. No matter the game, she was better than you. I have very clear memories of painful walks to the beach with her in the early summers. The walks were painful because she wouldn’t allow sandals, so we would develop calluses on our feet to protects from stepping on shells in the water. I also remember, at the age of 10 going to see her in the hospital. I was too young to really understand what was going on. I just knew that my grandmother, usually so full of energy was plugged into a machine that made her tired. Dad said the machine was helping her kidneys, I didn’t really know what a kidney was at the time. I just trusted that she needed it. Unfortunately she died about 6 months after that first visit.


Some 20 years later, having just completed my training in vascular surgery, I have met hundreds of people in the same condition as my grandmother. The number of people requiring dialysis has increased greatly since my grandmother’s time and so has the life span of people on dialysis. That combination means more dialysis patients needing access and needing it for longer. The need for optimal dialysis access has increased and will increase even more. So what does this mean for you? Who needs dialysis access? What is the optimal dialysis access?


Well, let’s take the second question first. The simple and definitive answer is the arterio-venous fistula, or AVF. During this procedure your surgeon hooks up one of your veins directly to one of your arteries. Doing this provides enough blood flow to allow the dialysis machines to work. Why is the optimal access? According to the national kidney foundation fistulas have:

  • Lower risk of clotting
  • Lower risk of infection
  • Reduced treatment times


Your body has many veins and many arteries but only one point needs to be selected for dialysis access and you and your surgeon should discuss this prior to any procedure. Many factors weigh on this decision, from anatomic factors regarding the arteries and veins, to whether you are a righty or a lefty, to what kind of hobbies you enjoy. All these factor need to be taken into account and are important to discuss with your surgeon. Here at the vascular experts we take a patient centered approach to these procedures to make sure that all of these factors are taken into account and to make sure that we fit the right access to the right patient. Naturally, all fistulas need to be monitored carefully. Here at The Vascular Experts you can expect routine monitoring visits so we can identify and repair any issues before they become problems.

Now for the first questions, Who needs dialysis access? The simple answer is people with renal failure. But like much in medicine the answer is never quite that simple. Most fistulas require 3 to 6 months to mature before they can be used. Thus it is essential to talk with your Nephrologist about when you will need dialysis. We take a team based approached, and work closely with our Nephrology, and primary care colleagues to identify people who will need this procedure, to identify any problematic fistulas and when possible to anticipate when an intervention will be needed or an access be created. Our goal is to provide a seamless experience to our patients so they can receive the care they need.

If you have renal problems it’s important that you find a surgeon who is fully trained in dialysis access, who practices a patient centered and team based approach to your care. Our goal at The Vascular Experts is to provide you with the vascular access care you need in a way that, like my grandmother, you can keep bowling or playing cards or doing those things you love doing. But if you will indulge my sore feet, please let your kids or grand kids wear sandals.

Please contact Dr. Kelly at with any additional questions.


Brian J. Kelly, MD 

Brian J. Kelly, MD is a board eligible vascular surgeon at The Vascular Experts, where he treats a full spectrum of vascular disease. His interests include aortic disease, carotid disease, peripheral arterial disease, and venous disease.   Read more»


Dr. Kelly practices at the Middletown, Manchester and Westbrook offices of The Vascular Experts.