Dialysis Care Locations
Dialysis Cares Performed
Treatment Available
About Our Dialysis Care Program
Expert Dialysis Access From Board-Certified Vascular Surgeons
The Dialysis Care program at Vascular Surgical Associates has been a trusted resource for kidney patients and their nephrologists across metro Atlanta since 1986. For patients with end-stage renal disease (ESRD) or advanced chronic kidney disease (CKD), reliable vascular access is not a convenience — it is a lifeline. Every hemodialysis session depends on it, and the quality of that access directly affects treatment outcomes, hospitalization rates, and quality of life.
Our board-certified vascular surgeons work closely with nephrology teams and dialysis centers to plan, create, and maintain the most appropriate access for each patient. We prioritize arteriovenous fistulas — the gold standard of dialysis access — whenever anatomy and timeline allow, and our surgeons have the expertise to construct fistulas in challenging anatomical situations where others may not. When a graft or catheter is necessary, we apply the same commitment to precision and durability.
Access management does not end after the initial procedure. Our team provides ongoing surveillance and intervention to keep dialysis access functioning at its best, using our ICAVL-accredited vascular laboratory for diagnostic imaging and our on-site Angio Suite for minimally invasive procedures such as angioplasty, thrombectomy, and catheter management — all in one coordinated program.
We understand that dialysis is a demanding and life-altering therapy. Our goal is to remove as many barriers and complications from that journey as possible by ensuring that when a patient arrives for dialysis, their access is ready, functional, and dependable.
What to Expect
Your Dialysis Access Journey
From your first consultation through long-term access management, our team guides you through every step with personalized attention and expert vascular care.
Access Planning Consultation
Meet with our vascular surgery team to review your kidney disease stage, dialysis timeline, medical history, and vein anatomy. Together we determine the optimal access type and timing for your situation.
Vascular Mapping
A comprehensive duplex ultrasound maps the veins and arteries in your arm, identifying the best vessels for fistula or graft construction and ensuring surgical planning is based on precise anatomical data.
Access Creation
Your access procedure — fistula, graft, or catheter — is performed by our board-certified vascular surgeons, typically on an outpatient basis. Most procedures take one to two hours and require only local or regional anesthesia.
Ongoing Monitoring & Maintenance
Regular surveillance with duplex ultrasound tracks access flow and maturation. If problems develop — stenosis, thrombosis, or inadequate flow — our team intervenes promptly to restore function and protect your access long-term.
Procedures We Offer
Comprehensive Dialysis Access Services
Our Dialysis Care program provides the full spectrum of access creation and maintenance procedures, tailored to each patient’s anatomy, timeline, and clinical needs.
Arteriovenous (AV) Fistula Creation
The gold-standard dialysis access, created by surgically connecting an artery directly to a vein — most often in the forearm or upper arm. A fistula uses the patient’s own vessels, offers the lowest complication and infection rates, and provides the most durable, long-lasting access when given adequate time to mature. Our surgeons maximize fistula creation in every appropriate candidate.
Arteriovenous (AV) Graft Placement
When native vessels are insufficient for fistula creation, a synthetic graft — a soft, biocompatible tube — is implanted to bridge an artery and vein and provide reliable dialysis access. Grafts are ready for use sooner than fistulas and are an excellent option for patients who need access quickly or whose vascular anatomy limits fistula options.
Tunneled Dialysis Catheter Placement
A soft, long-term catheter is placed in a central vein — typically the internal jugular — and tunneled beneath the skin to exit at the chest. Tunneled catheters provide immediate dialysis access when a fistula or graft is not yet ready or is not feasible. Our team places catheters using real-time ultrasound and fluoroscopic guidance to maximize safety and placement accuracy.
Fistula Maturation & Balloon-Assisted Maturation
Some fistulas develop slowly or fail to reach adequate size and flow for reliable cannulation. Our team monitors maturation with serial duplex ultrasound and, when necessary, performs balloon-assisted maturation (BAM) — a minimally invasive angioplasty technique performed in our Angio Suite that dilates the vein and accelerates fistula development without the need for repeat open surgery.
Access Angioplasty & Thrombectomy
Narrowing (stenosis) and clotting (thrombosis) are the most common causes of dialysis access failure. Our vascular surgeons perform catheter-based angioplasty — balloon dilation of narrowed segments — and mechanical or pharmacologic thrombectomy to restore flow and rescue failing or clotted accesses. These procedures are performed in our on-site Angio Suite, often allowing patients to resume dialysis the same day.
Catheter Exchange & Removal
When a tunneled catheter malfunctions, becomes infected, or is no longer needed following successful fistula or graft maturation, our team performs catheter exchange or removal using image-guided techniques. Prompt management of catheter-related problems reduces infection risk and prevents complications that can threaten both vascular access and the patient’s overall health.
Access Surveillance & Flow Studies
Routine duplex ultrasound surveillance of arteriovenous fistulas and grafts detects early stenosis and flow changes before they cause access failure. Our ICAVL-accredited vascular laboratory performs comprehensive access flow studies, and our surgeons act on findings promptly — keeping access functional and reducing emergency interventions and hospitalizations.
Steal Syndrome Treatment (DRIL Procedure)
In some patients, arteriovenous access diverts too much blood flow away from the hand, causing pain, numbness, or tissue damage — a condition called dialysis access steal syndrome. Our surgeons perform the Distal Revascularization-Interval Ligation (DRIL) procedure, which restores blood flow to the hand while preserving the fistula or graft, resolving symptoms and protecting limb health.
Peritoneal Dialysis Catheter Placement
For patients who choose peritoneal dialysis — a home-based dialysis modality performed through the abdomen — our surgeons place peritoneal dialysis catheters laparoscopically or via a minimally invasive open technique. Proper catheter placement and exit-site positioning are critical to long-term PD catheter function, and our surgical team follows best-practice protocols to optimize outcomes for PD patients.
Fistula-First Approach
We prioritize native arteriovenous fistulas for every appropriate patient, consistent with national guidelines. Fistulas last longer, cause fewer infections, and result in better outcomes than grafts or catheters.
Coordinated with Your Nephrology Team
We work directly with your nephrologist and dialysis center to align access planning with your kidney disease progression, ensuring the right access is ready at the right time.
Same-Location Angio Suite
Surveillance, angioplasty, thrombectomy, and catheter procedures are all performed in our on-site Angio Suite. No hospital referral needed — faster intervention, faster return to dialysis.
Insurance & Medicare Covered
Dialysis access procedures are medically necessary and covered by Medicare, Medicaid, and most major insurance plans. Our team verifies your benefits before scheduling.
Dialysis Care Locations
Our Dialysis Care services are available at multiple convenient metro Atlanta locations, keeping expert vascular access care close to home and close to your dialysis center.
Marietta
61 Whitcher Street Suite 2100
Marietta, GA 30060
Phone: (770) 423-0595
Hours: Mon–Fri, 8 AM – 5 PM
East Cobb
3747 Roswell Rd, Suite 316,
Marietta, GA 30062
Phone: (770) 423-0595
Hours: Mon–Fri, 8 AM – 5 PM
Douglasville
6095 Professional Pkwy,Suite B203, Douglasville, GA 30134
Phone: (770) 423-0595
Hours: Mon–Fri, 8 AM – 5 PM
Frequently Asked Questions
Common questions about dialysis access care at Vascular Surgical Associates.
An arteriovenous (AV) fistula is universally recognized as the gold standard for hemodialysis access. Fistulas use the patient’s own vessels, carry the lowest risk of infection and clotting, and typically last the longest of any access type. Our surgeons prioritize fistula creation for every patient where anatomy and timeline allow. When a fistula is not possible, an AV graft or tunneled catheter may be appropriate, and our team will discuss all options with you in detail.
Most arteriovenous fistulas require six weeks to several months to mature sufficiently for hemodialysis cannulation — a process called “fistula maturation.” During this period, the vein wall thickens and the vessel enlarges in response to increased blood flow. This is why planning and creating a fistula well in advance of when dialysis is needed is so important. Our team monitors maturation with duplex ultrasound and can perform balloon-assisted maturation (BAM) to accelerate development in fistulas that are maturing slowly.
Most dialysis access procedures — including AV fistula and graft creation — are performed on an outpatient basis, meaning patients go home the same day. Procedures are done under local or regional anesthesia, not general anesthesia, in the majority of cases. Catheter placements and Angio Suite interventions (angioplasty, thrombectomy) are also typically outpatient procedures. Hospital-based surgery may be necessary in select complex cases, and our team will advise you based on your individual situation.
Contact our office immediately. A fistula or graft that has clotted requires urgent intervention — typically within 24 to 48 hours — to maximize the chance of successful salvage. Signs of access failure include inability to feel the normal “thrill” (vibration) or hear the “bruit” (rushing sound) at your access site, or being told at your dialysis center that flow rates are inadequate. Our team prioritizes urgent access interventions and our on-site Angio Suite allows rapid response without the delays of hospital-based scheduling.
