---
title: "The Vascular Specialist’s Role in Dialysis: From Permacaths to Fistulas"
description: Discover the crucial role vascular specialists play in dialysis, from emergency Permacath placement to long-term AV fistulas and grafts, ensuring effective and safe patient care.
image: https://vascular.tcvcg.com/hubfs/iStock-1156991164.jpg
---
The Vein Institute of New Jersey is considered one of the top vein centers in the world. [Visit The Vein Institute](https://www.veininstitutenj.com/)
[Patient Portal](https://gateway.aprima.com/portal/home/11101) [Careers](https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=01ac20b2-794f-4cd2-b641-85102eaee82c&ccId=19000101_000001&lang=en_US&selectedMenuKey=CareerCenter)
[](http://tcvcg.com/)
[973-759-9000](tel:9737599000) [Schedule Appointment](http://tcvcg.com/contact-us/scheduling-appointments/)
- [Contact Us](https://tcvcg.com/contact-us/)
- [Locations](https://tcvcg.com/contact-us/locations/)
- [Patient Forms](https://tcvcg.com/registration)
- [Scheduling Appointments](https://tcvcg.com/contact-us/scheduling-appointments/)
- [Hospital Consults](https://tcvcg.com/consult/)
- [Our Practice](https://tcvcg.com/our-practice/)
- - [Our Providers](https://tcvcg.com/our-practice/our-providers/)
- [Leadership & Integrity](https://tcvcg.com/our-practice/leadership-integrity/)
- [Noninvasive Vascular Laboratory](https://tcvcg.com/our-practice/noninvasive-vascular-laboratory/)
- [Vein Treatment Center](https://tcvcg.com/our-practice/vein-treatment-center/)
- [Hospital Affiliations](https://tcvcg.com/our-practice/hospital-affiliations/)
- - [Patient Testimonials](https://tcvcg.com/our-practice/patient-testimonials/)
- [Awards & Media](https://tcvcg.com/our-practice/awards-media/)
- [Vascular Clinical Trials](https://tcvcg.com/our-practice/vascular-clinical-trials/)
- [History](https://tcvcg.com/our-practice/history/)
- [Vascular Conditions](https://tcvcg.com/vascular-conditions/)
- - [Peripheral Artery Disease (“PAD”)](https://tcvcg.com/vascular-conditions/peripheral-artery-disease-pad/)
- [Carotid Artery Disease](https://tcvcg.com/vascular-conditions/carotid-artery-disease/)
- [Aortic Aneurysms](https://tcvcg.com/vascular-conditions/aortic-aneurysms/)
- - [Hemodialysis Access](https://tcvcg.com/vascular-conditions/hemodialysis-access/)
- [Vein Disease](https://tcvcg.com/vascular-conditions/vein-disease/)
- [TCVCG Vascular Screening](https://tcvcg.com/vascular-conditions/tcvcg-vascular-screening-program/)
- [Treatments](https://tcvcg.com/treatments/)
- - [Peripheral Artery Disease (“PAD”)](https://tcvcg.com/treatments/peripheral-artery-disease-pad/)
- [Carotid Artery Disease](https://tcvcg.com/treatments/causes-and-care-for-carotid-artery-disease/)
- [Abdominal Aortic Aneurysm](https://tcvcg.com/treatments/abdominal-aortic-aneurysm/)
- - [Dialysis Access Care](https://tcvcg.com/treatments/dialysis-access-care/)
- [Procedure Suite](https://tcvcg.com/treatments/procedure-suite/)
- [Vein Care](https://tcvcg.com/treatments/vein-care/)
- [Patient Info](https://tcvcg.com/patient-info/)
- - [Contact Us](https://tcvcg.com/contact-us/)
- [e-Book Library](https://tcvcg.com/e-book-library/)
- [Falls Prevention](https://tcvcg.com/tcvcg-falls-prevention-guide/)
- [Healthy Recipes](https://tcvcg.com/healthy-recipes/)
- [Insurance & Billing](https://tcvcg.com/patient-info/insurance-billing/)
- [Know Your Vascular Health](https://tcvcg.com/patient-info/know-your-vascular-health/)
- - [Leg Swelling Assessment](https://tcvcg.com/leg-swelling-assessment/)
- [Medical Record Request](https://tcvcg.com/medical-record-request/)
- [PAD Assessment](https://tcvcg.com/pad-assessment/)
- [Patient Forms](https://tcvcg.com/registration)
- [Second Opinions](https://tcvcg.com/what-you-should-know-about-second-opinions/)
- [Videos](https://tcvcg.com/patient-info/videos/)
- [Blog](https://vascular.tcvcg.com/blog/)
- [Contact Us](https://tcvcg.com/contact-us/)
- [Locations](https://tcvcg.com/contact-us/locations/)
- [Patient Forms](https://tcvcg.com/registration)
- [Scheduling Appointments](https://tcvcg.com/contact-us/scheduling-appointments/)
- [Hospital Consults](https://tcvcg.com/consult/)
- [Our Practice](https://tcvcg.com/our-practice/)
- - [Our Providers](https://tcvcg.com/our-practice/our-providers/)
- [Leadership & Integrity](https://tcvcg.com/our-practice/leadership-integrity/)
- [Noninvasive Vascular Laboratory](https://tcvcg.com/our-practice/noninvasive-vascular-laboratory/)
- [Vein Treatment Center](https://tcvcg.com/our-practice/vein-treatment-center/)
- [Hospital Affiliations](https://tcvcg.com/our-practice/hospital-affiliations/)
- - [Patient Testimonials](https://tcvcg.com/our-practice/patient-testimonials/)
- [Awards & Media](https://tcvcg.com/our-practice/awards-media/)
- [Vascular Clinical Trials](https://tcvcg.com/our-practice/vascular-clinical-trials/)
- [History](https://tcvcg.com/our-practice/history/)
- [Vascular Conditions](https://tcvcg.com/vascular-conditions/)
- - [Peripheral Artery Disease (“PAD”)](https://tcvcg.com/vascular-conditions/peripheral-artery-disease-pad/)
- [Carotid Artery Disease](https://tcvcg.com/vascular-conditions/carotid-artery-disease/)
- [Aortic Aneurysms](https://tcvcg.com/vascular-conditions/aortic-aneurysms/)
- - [Hemodialysis Access](https://tcvcg.com/vascular-conditions/hemodialysis-access/)
- [Vein Disease](https://tcvcg.com/vascular-conditions/vein-disease/)
- [TCVCG Vascular Screening](https://tcvcg.com/vascular-conditions/tcvcg-vascular-screening-program/)
- [Treatments](https://tcvcg.com/treatments/)
- - [Peripheral Artery Disease (“PAD”)](https://tcvcg.com/treatments/peripheral-artery-disease-pad/)
- [Carotid Artery Disease](https://tcvcg.com/treatments/causes-and-care-for-carotid-artery-disease/)
- [Abdominal Aortic Aneurysm](https://tcvcg.com/treatments/abdominal-aortic-aneurysm/)
- - [Dialysis Access Care](https://tcvcg.com/treatments/dialysis-access-care/)
- [Procedure Suite](https://tcvcg.com/treatments/procedure-suite/)
- [Vein Care](https://tcvcg.com/treatments/vein-care/)
- [Patient Info](https://tcvcg.com/patient-info/)
- - [Contact Us](https://tcvcg.com/contact-us/)
- [e-Book Library](https://tcvcg.com/e-book-library/)
- [Falls Prevention](https://tcvcg.com/tcvcg-falls-prevention-guide/)
- [Healthy Recipes](https://tcvcg.com/healthy-recipes/)
- [Insurance & Billing](https://tcvcg.com/patient-info/insurance-billing/)
- [Know Your Vascular Health](https://tcvcg.com/patient-info/know-your-vascular-health/)
- - [Leg Swelling Assessment](https://tcvcg.com/leg-swelling-assessment/)
- [Medical Record Request](https://tcvcg.com/medical-record-request/)
- [PAD Assessment](https://tcvcg.com/pad-assessment/)
- [Patient Forms](https://tcvcg.com/registration)
- [Second Opinions](https://tcvcg.com/what-you-should-know-about-second-opinions/)
- [Videos](https://tcvcg.com/patient-info/videos/)
- [Blog](https://vascular.tcvcg.com/blog/)
Menu
The Vein Institute of New Jersey is considered one of the top vein centers in the world. [Visit The Vein Institute](https://www.veininstitutenj.com/)
[Patient Portal](https://gateway.aprima.com/portal/home/11101) [Careers](https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=01ac20b2-794f-4cd2-b641-85102eaee82c&ccId=19000101_000001&lang=en_US&selectedMenuKey=CareerCenter)
[](http://tcvcg.com/)
[973-759-9000](tel:9737599000) [Schedule Appointment](http://tcvcg.com/contact-us/scheduling-appointments/)
- [Contact Us](https://tcvcg.com/contact-us/)
- [Locations](https://tcvcg.com/contact-us/locations/)
- [Patient Forms](https://tcvcg.com/registration)
- [Scheduling Appointments](https://tcvcg.com/contact-us/scheduling-appointments/)
- [Hospital Consults](https://tcvcg.com/consult/)
- [Our Practice](https://tcvcg.com/our-practice/)
- [Our Providers](https://tcvcg.com/our-practice/our-providers/)
- [Leadership & Integrity](https://tcvcg.com/our-practice/leadership-integrity/)
- [Noninvasive Vascular Laboratory](https://tcvcg.com/our-practice/noninvasive-vascular-laboratory/)
- [Vein Treatment Center](https://tcvcg.com/our-practice/vein-treatment-center/)
- [Hospital Affiliations](https://tcvcg.com/our-practice/hospital-affiliations/)
- [Patient Testimonials](https://tcvcg.com/our-practice/patient-testimonials/)
- [Awards & Media](https://tcvcg.com/our-practice/awards-media/)
- [Vascular Clinical Trials](https://tcvcg.com/our-practice/vascular-clinical-trials/)
- [History](https://tcvcg.com/our-practice/history/)
- [Vascular Conditions](https://tcvcg.com/vascular-conditions/)
- [Peripheral Artery Disease (“PAD”)](https://tcvcg.com/vascular-conditions/peripheral-artery-disease-pad/)
- [Carotid Artery Disease](https://tcvcg.com/vascular-conditions/carotid-artery-disease/)
- [Aortic Aneurysms](https://tcvcg.com/vascular-conditions/aortic-aneurysms/)
- [Hemodialysis Access](https://tcvcg.com/vascular-conditions/hemodialysis-access/)
- [Vein Disease](https://tcvcg.com/vascular-conditions/vein-disease/)
- [Free Vascular Screening](https://tcvcg.com/vascular-conditions/free-vascular-screening-program/)
- [Treatments](https://tcvcg.com/treatments/)
- [Peripheral Artery Disease (“PAD”)](https://tcvcg.com/treatments/peripheral-artery-disease-pad/)
- [Carotid Artery Disease](https://tcvcg.com/treatments/causes-and-care-for-carotid-artery-disease/)
- [Abdominal Aortic Aneurysm](https://tcvcg.com/treatments/abdominal-aortic-aneurysm/)
- [Dialysis Access Care](https://tcvcg.com/treatments/dialysis-access-care/)
- [Procedure Suite](https://tcvcg.com/treatments/procedure-suite/)
- [Vein Care](https://tcvcg.com/treatments/vein-care/)
- [Patient Info](https://tcvcg.com/patient-info/)
- [Contact Us](https://tcvcg.com/contact-us/)
- [e-Book Library](https://tcvcg.com/e-book-library/)
- [Falls Preventioin](https://tcvcg.com/tcvcg-falls-prevention-guide/)
- [Healthy Recipies](https://tcvcg.com/healthy-recipes/)
- [Insurance & Billing](https://tcvcg.com/patient-info/insurance-billing/)
- [Know Your Vascular Health](https://tcvcg.com/patient-info/know-your-vascular-health/)
- [Leg Swelling Score](https://tcvcg.com/leg-swelling-assessment/)
- [Medical Record Request](https://tcvcg.com/medical-record-request/)
- [PAD Assessment](https://tcvcg.com/pad-assessment/)
- [Patient Forms](https://tcvcg.com/registration)
- [Second Opinions](https://tcvcg.com/what-you-should-know-about-second-opinions/)
- [Videos](https://tcvcg.com/patient-info/videos/)
- [Blog](https://vascular.tcvcg.com/blog/)
- [Patient Portal](https://gateway.aprima.com/portal/home/11101)
- [Careers](https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=01ac20b2-794f-4cd2-b641-85102eaee82c&ccId=19000101_000001&lang=en_US&selectedMenuKey=CareerCenter)
-
-
## The Vascular Specialist’s Role in Dialysis: From Permacaths to Fistulas
-
- [The Cardiovascular Care Group Blog](https://vascular.tcvcg.com/blog)
- The Vascular Specialist’s Role in Dialysis: From Permacaths to Fistulas
The Vascular Specialist’s Role in Dialysis: From Permacaths to Fistulas
5:08
Dec 26, 2025 10:10:47 AM Dr. Neil Poulsen, MD
When patients reach **end-stage renal disease (ESRD)** and their kidneys can no longer filter waste and fluid effectively, one of the first and most urgent medical needs becomes establishing safe and reliable **vascular access** for dialysis.
While nephrologists manage kidney disease and dialysis plans, **vascular surgeons play a critical and ongoing role** in creating, maintaining, and preserving the lifelines that make dialysis possible.
At **The Cardiovascular Care Group**, our multidisciplinary collaboration with nephrologists, dialysis centers, and hospital teams ensures that patients receive the right access at the right time—with long-term planning in mind.
## Understanding ESRD and the Urgency of Access
As kidney function declines to its final stages, patients may experience:
- Severe fatigue
- Fluid retention
- Abnormal electrolytes
- Uremic symptoms like nausea and confusion
Often, patients with ESRD require **urgent hospitalization**. In many cases, there is not yet a mature long-term dialysis access in place, so the medical team must act quickly to begin life-sustaining dialysis.
This is where vascular specialists step in.
## Step One: Emergency Access – The Permacath
### What Is a Permacath?
A **tunneled hemodialysis catheter**, often called a **Permacath**, is placed into a major central vein (usually the internal jugular). It allows dialysis to begin **immediately**.
### Why It’s Used
- It provides **rapid access** in emergent settings.
- It is ideal when there is **no time** to create a fistula or graft.
- It bridges the gap while long-term access is planned and prepared.
However, Permacaths are not a long-term solution. They carry higher risks of:
- Infection
- Clotting
- Central vein stenosis
Due to these risks, the goal is always to transition patients to the safest long-term option as soon as possible.
## Planning for Long-Term Access: The Mapping Stage
Once the patient is stabilized, the next step is **vein mapping**, performed in our **in-office Noninvasive Vascular Laboratory**, accredited and staffed by experienced vascular technologists.
### Vein Mapping Helps Determine:
- Which arm has the best vein quality
- Whether a naturally occurring connection (fistula) is feasible or if a graft is required
- The best location for access to promote longevity and ease of use
This diagnostic step ensures the patient receives the most suitable form of long-term access.
## Long-Term Dialysis Access Options: AV Fistulas and AV Grafts
### Arteriovenous Fistula (AVF): The Gold Standard
An **arteriovenous fistula** is created when a vascular surgeon connects an artery to a vein, usually in the arm. Over time, the vein becomes larger and stronger, making it ideal for repeated dialysis needle placement.
### Benefits of an AVF:
- Longest lifespan of any access
- Lowest risk of infection
- Best overall performance for dialysis
However, an AVF requires **weeks to months** to fully mature. During this time, the Permacath remains in place until the fistula is ready.
### Arteriovenous Graft (AVG): A Reliable Alternative
If a patient’s veins are too small or unsuitable for an AVF, an **arteriovenous graft** may be recommended. This involves using a synthetic tube to connect the artery and vein.
### Advantages of an AVG:
- Can be used sooner than a fistula
- Ideal for patients with limited vein quality
- Still provides durable, repeatable access
While AVGs have a slightly higher risk of complications compared to fistulas, they remain an excellent long-term option.
## Ongoing Management and Surveillance
The work of the vascular surgeon doesn’t end once access is created. Dialysis access requires **continuous monitoring** to prevent complications and ensure optimal performance.
At The Cardiovascular Care Group, we provide:
### Routine Surveillance
- Ultrasound exams to check flow and detect narrowing
- Monitoring for clotting, swelling, or malfunction
### Intervention When Needed
- Angioplasty to open narrowing
- Thrombectomy for clot removal
- Revision procedures to salvage failing access
Working hand-in-hand with dialysis nurses and nephrologists, our goal is always the same: **keep the access working and keep the patient safely dialyzing**.
## A Collaborative Approach to Lifelong Care
Dialysis patients rely on a strong support network. At every stage from emergency catheter placement to long-term access management, **vascular surgeons are essential members of the care team**.
Our collaboration with:
- **Nephrologists**
- **Dialysis centers**
- **Hospital teams**
- **Primary care providers**
ensures that patients receive seamless care and timely intervention.
## The Cardiovascular Care Group: Your Partner in Dialysis Access
Since 1963, The Cardiovascular Care Group has been committed to excellence in vascular and endovascular care. As one of New Jersey’s most experienced vascular practices, we are proud to help guide patients through every phase of dialysis access from initial diagnosis through long-term management.
If you or a loved one needs dialysis access evaluation, fistula creation, or ongoing access care, our specialists are here to help.
[](https://cta-redirect.hubspot.com/cta/redirect/6302898/6f573a69-415d-4436-b5b0-366ef20aa221)
## Featured posts
### Categories
- [Aortic Aneurysms (11)](https://vascular.tcvcg.com/blog/tag/aortic-aneurysms)
- [Carotid Artery Disease (18)](https://vascular.tcvcg.com/blog/tag/carotid-artery-disease)
- [Health/Exercise (22)](https://vascular.tcvcg.com/blog/tag/health-exercise)
- [Hemodialysis (7)](https://vascular.tcvcg.com/blog/tag/hemodialysis)
- [Peripheral Artery Disease (23)](https://vascular.tcvcg.com/blog/tag/peripheral-artery-disease)
- [Travel (4)](https://vascular.tcvcg.com/blog/tag/travel)
- [Vascular Doctors/Staff (17)](https://vascular.tcvcg.com/blog/tag/vascular-doctors-staff)
- [Vascular Treatments (27)](https://vascular.tcvcg.com/blog/tag/vascular-treatments)
- [Vein Conditions (61)](https://vascular.tcvcg.com/blog/tag/vein-conditions)
- [Vein Treatments (47)](https://vascular.tcvcg.com/blog/tag/vein-treatments)
### Subscribe to TCVCG Health News
## Contact Us
#### To contact us or schedule an appointment call (973) 759-9000 or fill out the form below
The Cardiovascular Care Group has six (6) convenient office locations throughout New Jersey. If you should have any questions regarding our practice specialties, hospital affiliations, insurance & billing or you just have a general question about the practice, please do not hesitate to contact us.
[View Locations](https://tcvcg.com/contact-us/locations/)
 [Visit the Vein Institute of New Jersey](https://www.veininstitutenj.com/)
[](https://tcvcg.com/our-practice/noninvasive-vascular-laboratory/) [](https://tcvcg.com/our-practice/noninvasive-vascular-laboratory/) [](https://tcvcg.com/our-practice/leadership-integrity//) [](https://tcvcg.com/our-practice/leadership-integrity/)
[_2.jpg)](https://castleconnolly.com/)
### Testimonials
I cannot say enough good things – and I’ve been to a lot of doctors. The staff is so friendly an...
- D., Neptune
I have been coming to The Cardiovascular Care Group for nearly two decades! Initially with my Dad wh...
- A., Clark
[Read More](http://tcvcg.com/our-practice/patient-testimonials/)
©2021-2024, The Cardiovascular Care Group. All rights reserved. [Terms and Conditions](http://tcvcg.com/terms-and-conditions/) [Privacy Policy](http://tcvcg.com/privacy-policy-2/) [Non-Discrimination](https://www.tcvcg.com/non-discrimination-notice) [HIPAA Notice](https://tcvcg.com/hipaa-omnibus-notice-of-privacy-practices/)
All information on this site is of a general nature and is furnished for your knowledge and understanding only.
This information is not to be taken as medical or other health advice pertaining to your specific health and medical condition.