Services offered by Michigan Vascular Access include:

Evaluation of end-stage renal disease patients for hemodialysis options. In the initial meeting with a new patient, an informed review of each patient's access history is coupled with a focused physical examination and ultrasound evaluation. All factors that will affect the choice of access are reviewed. Options are discussed, and an approach (which may or may not include surgery) is recommended. In those patients whose complicated medical history or previous surgery makes additional studies necessary, every attempt is made to get those studies done and move on to the solution of the problem as soon as possible.

Our experience and knowledge of past results informs the discussion of the various choices, and helps the patient make a sensible choice that meets his or her individual circumstances.

Office ultrasound examination of veins and arteries for use in dialysis access. An ultrasound exam of both arms (usually) is done at the initial visit in the process of discovering the individual patient’s arterial and venous anatomy. Patients who have previous “mapping” or x-rays done are encouraged to bring all the information they have to the initial evaluation, but we believe that the “real time” ultrasound examination should be done by the surgeon who will do the surgery to get the best results

Creation of fistulas (using native veins) and placement of grafts (placement of Teflon tubes under the skin) for dialysis. Once the choice as been made, or the recommendation accepted, the patient is scheduled for a procedure in the hospital by Dr. Webb. On rare occasions, the patient might be recommended to have his or her procedure done by another practitioner with special skills. The procedures are usually done on an outpatient basis, but the occasional patient may require an overnight stay.

Diagnosis and management of graft and fistula problems. Michigan Vascular Access, PC follows most patients in a “case management “ model, meaning that patients are encouraged to return with their problems. Knowledge of the patient’s history, previous examinations and procedures, and x-rays in the file help guide a focused examination and problem solving session. Ultrasound is almost always helpful. Frequently, cannulation problems may be due to an incomplete understanding of the patient’s individual access. If so, feedback to the unit, with or without a ultrasound-guided digital photo diagram (see below) may solve the problem. If an endovascular procedure or an actual operation is advisable, they can be arranged at the earliest or most convenient moment.

Endovascular (minimally invasive) evaluation and correction of vascular abnormalities complicating dialysis accesses. If an abnormality in a dialysis access is detected or suspected that may respond to endovascular intervention (procedures that do not require incisions), the patient may be advised to have a shuntogram. The access is punctured with a needle, and all interventions are done through the puncture. Narrowings can be stretched, clot can be removed, and stents can be placed, with the goal to save or improve the dialysis access in the least disruptive way possible. These “tune-ups” are normally done as an outpatient.

Dr. Webb has extensive experience with complications of dialysis access, and as lectured nationally on early cannulation grafts, covered stents in the management of outflow problems, and management of central stenosis.

Operative revision of fistulas and grafts. When a dialysis access is damaged, dysfunctional, or deteriorating, but still has value, a revision may be recommended to restore or save the access. Replacement of a damaged section, removal of an aneurysm, branch ligation, and flow reduction and so on - many procedures are offered as needed. Every effort is made to provide a solution that does not require placement of a temporary catheter, but sometimes this is necessary. Dr. Webb has extensive experience with early cannulation grafts that can help avoid catheter placement, and has lectured on this subject nationally.

Standards.

Open surgical and endovascular techniques are employed by an experienced board-certified surgeon in a C-arm fluoroscope-equipped operating room, always with anesthesia support, and always in a JCAHO-accredited hospital. For the last twelve years (with a handful of exceptions), Dr. Webb has done all of his own procedures without assistants or trainees.

Michigan Vascular Access, PC, keeps extensive records, and attempts to report results yearly.