The Vascular Access Center
Kidney Care and Transplant Services of New England provides hemodialysis vascular access care and venous access procedures in a modern, state-of-the-art outpatient facility called The Vascular Access Center (VAC). The center provides timely interventional procedures in a setting that is convenient, comfortable, and friendly. The VAC has been serving patients since 2005 and more than 13,000 procedures have been performed by the staff. Located at 208 Ashley Avenue in West Springfield, MA, the VAC has easy on and off access to the I-91 highway.
The Vascular Access Center is accredited by the Accreditation Association for Ambulatory Health Care which has developed
standards to promote patient safety and quality care. The center is staffed by the following American Board of
Surgery certified surgeons:
The surgeons are partners of Kidney Care and Transplant Services of New England and provide additional surgical services beyond vascular access procedures. For more information on other surgical services click here.
Services offered at The Vascular Access Center
Dialysis Access Procedures
In order to receive hemodialysis, you need a functioning vascular access. Your hemodialysis vascular access can be
considered your "lifeline." At The Vascular Access Center, we provide the following services to maintain
- Fistulagram / Angiogram: When your access (fistula or graft) is not functioning properly, you
may be scheduled for an X-ray of your access to diagnose the cause of the access malfunction. A needle is
inserted into your access and contrast material (X-ray dye) is injected to determine the cause of the malfunction.
This X-ray is called a "fistulagram" or an "angiogram."
- Balloon Angioplasty: If the problem in your access such as a narrowed area is seen on the fistulagram,
a special catheter with a balloon at the tip can be threaded through a needle into your access and inflated
to dilate the narrowed area. This procedure is called an angioplasty and can be done to improve the function
of your access in many cases.
Stent Placement: If the narrowed area in your access is not adequately treated with angioplasty,
a stent can be threaded into your access through the same needle and placed to hold open the narrowed area.
A stent is a small plastic tube that is reinforced with a fine metal mesh.
- Declot / Thrombectomy: If your access becomes completely blocked ("clotted" or "thrombosed")
and cannot be used for hemodialysis, a procedure called a thrombectomy (or "declot") can be performed
to re-establish blood flow in your access. This procedure can sometimes be done through needles but can also
require a small incision over your access. After the blood flow is re-established, a fistulagram will be
performed to determine what caused your access to clot.
- Fistula Collateral Vein Ligation: After a fistula is created in your arm, it will be evaluated
periodically with an ultrasound examination. In some people, 1 or more small vein branches may drain blood
away from the fistula. In this case, the surgeon may need to block off the vein branch with a suture in order
to help your fistula develop into a functional access for hemodialysis.
- Fistula Maturation Procedures: After a fistula is created in your arm, it will need to dilate
("mature") over the course of 6-8 weeks. If it does not dilate adequately, a procedure can be done
with an angioplasty balloon to mechanically dilate the fistula. This often takes several sessions spread
out over 1-2 months to dilate the fistula to a size that can be used for hemodialysis. This procedure is
referred to as a Balloon Angioplasty Maturation procedure or "BAM."
- Access Ultrasound: When your access is maturing or if there is a problem with your access, you
may be scheduled for an ultrasound examination of your access.
- Preoperative Vascular Ultrasound: When you and your kidney doctor (nephrologist) have determined
that you will need hemodialysis in the coming months, you will be scheduled at the VAC for an ultrasound
of the blood vessels in your arm. With this information, a plan can be made for which arm and which blood
vessels will be used to create your access.
Venous Access Procedures
- Short-term and Long-term Venous Catheter Management: Many patients require the insertion of
plastic catheters called "central venous catheters." Different types of catheters can be used for
hemodialysis, chemotherapy, intravenous antibiotic administration and intravenous nutrition. These catheters
are essentially larger versions of the "IV's" that are usually placed in an arm vein for intravenous
fluids. Because these catheters are larger, they must be placed into the larger veins in the body called
the "central veins." At the VAC, these catheters can be inserted, replaced if not functioning properly,
and removed when no longer needed.
- Venous Access Port Management In some people, a subcutaneous port is placed under the skin for
access to their venous system. In contrast to a catheter which protrudes through the skin, a port is a small
plastic device that is inserted completely under the skin. This is usually performed on the upper chest wall
but can be inserted in many places in the body. At the VAC, these ports can be inserted, replaced if not
functioning properly, and removed when no longer needed.
Skin and Subcutaneous Minor Procedures
- Removal of Skin Lesions and Small, Subcutaneous Masses: Small skin growths, tumors and subcutaneous
masses can be removed under local anesthesia at the VAC. The tissue that is removed is sent to a local hospital
for a diagnosis by a pathologist.