Dialysis Access Management
in Fredericksburg, VA

Dialysis access management refers to the long-term maintenance of the devices used to connect patients to their dialysis machine. Ensuring the proper functioning of those devices is an integral component of receiving dialysis care.

Virginia Interventional and Vascular Associates (VIVA) serves the Greater Fredericksburg community in offering the most convenient and highest quality dialysis access management in the region. Our Vascular Surgeons, Drs. Larry Koenig, III and Victor J. D’Addio, implant grafts and fistulas, and Interventional Radiologists at VIVA, implant catheters and manage fistulas and grafts. Over time, patients require maintenance of these access sites which can be managed through VIVA. These services may include, but are not limited to, fistulagrams, declots, catheter exchanges, and surgical revisions. On a long-term basis, patients require maintenance of these accesses. These maintenance services are also managed through VIVA, including thrombectomies, angioplasties, and surgical revisions.

All patients receiving dialysis must have an access created to perform this life-saving procedure. Our multidisciplinary team of Board Certified, Fellowship Trained Interventional Radiologists and Vascular Surgeons create and manage quality dialysis access.

For patients who experience kidney failure, dialysis is a lifesaving treatment process. The function of the kidneys is to filter toxins in the blood and expel them through the urine. When kidneys are incapable of functioning properly, removing the toxins is vital. Through dialysis, toxins in the bloodstream are filtered from the body. Dialysis access provides a connection point to the bloodstream.

“Dialysis access management is the long-term maintenance of these devices to ensure that they function correctly and last as long as possible. All of these devices are critical to the health of the dialysis patient, which makes them invaluable. Maintaining them is extremely important.”
Dr. F. Larry Koenig, III

Dialysis Access at VIVA

Dialysis access refers to the devices and vascular access used to create the mode of connection to dialysis treatment. Through a minor surgical procedure, catheters, fistulas, and grafts are implanted under the skin. These access devices make a connection to dialysis machines possible.

Dialysis access management refers to the long-term maintenance of the devices used to connect patients to their dialysis machine. Ensuring the proper functioning of those devices is an integral component of receiving dialysis care.


Providing dialysis access management at VIVA in the outpatient setting is all about providing patients in our community with the highest level of care in the most convenient way possible. Our outpatient facility also offers a high value for patients within a lower cost alternative. VIVA’s staff of experts are dedicated to attentively serving your needs throughout the entire dialysis access management process.

At VIVA, you’ll find:

Timely access

Highest level of quality and expertise

Comfortable environment


Why choose Virginia Interventional and Vascular Associates of Fredericksburg?

As a multi-specialty practice, VIVA is able to provide comprehensive care for your dialysis access management in addition to a full complement of interventional radiology services. We provide the highest quality of care by meeting rigorous standards established by accreditation organizations, including AAAHC and IAC. At VIVA, you’ll find the area’s only multi-specialty team of Interventional Radiologists and Vascular Surgeons who are Board Certified and Fellowship Trained.

Dialysis access management at VIVA:

  • The process is efficient
  • Atmosphere is pleasant and comfortable
  • Location is convenient and easily accessible
  • Care is personalized, attentive, and ongoing

At VIVA, you aren’t just another patient. In our state-of-the-art facility, you have the opportunity to receive personalized care. It’s the benefit of having a dedicated specialist who knows who you are. From the receptionist to your surgical team, our staff of medical professionals are dedicated to providing you with individualized care at the best value in the region.

There are 4 types of dialysis access:

The type of dialysis access that you require depends on the dialysis treatment you need to receive.

A peritoneal catheter is a soft, flexible plastic tube placed in the lower abdomen to allow for peritoneal dialysis. Peritoneal dialysis uses the lining of your belly cavity and a dialysate fluid which absorbs waste from the body.
An AV fistula is created by connecting one of your arteries to one of your veins using your own vessels.
Fistulas are the preferred mode of access because of the following benefits:

  • They provide good blood flow
  • Generally last longer than other types of access
  • Most natural form of access

Before your fistula surgery, you may undergo an ultrasound to determine whether your veins are large enough for a fistula.

An AV graft functions in the same way as a fistula. You may be a candidate for a graft if your veins are too small to support a fistula. A graft is essentially a plastic tube that is inserted into your arm to connect to an artery or vein.
A central venous catheter is a flexible, y-shaped tube inserted into a central vein in your neck, chest, or groin. A CVC is typically used as a temporary means of access. The advantage is that it is quickly placed and quickly removed, making it an ideal solution if you have an immediate need for dialysis.

What can I expect during my dialysis access procedure?

An outpatient surgical procedure is required to create most pathways for receiving dialysis treatment. During a vascular access surgery, fistulas and grafts are placed under the skin, most commonly in the arm. Peritoneal and hemodialysis catheters can be placed using minimally invasive procedural techniques.

“Dialysis access implantation is a minor surgery, but they are very elegant little procedures and require a significant amount of training,” according to Dr. Larry Koenig III. “General surgeons and vascular surgeons are the types of doctors who implant these devices. Myself and Dr. D’Addio are both Board Certified Vascular Surgeons and have done thousands of these procedures between the two of us and have had very good results.”

Brief & Minimally Invasive

Involves very little pain

Minimal recovery time


After your procedure, you may be prescribed pain medication as well as ice and elevation to reduce swelling. For patients who have a fistula placed, we may recommend some strengthening exercises, such as squeezing a stress ball.

Schedule an Appointment

Why your access needs maintenance

At VIVA, we feel passionate about remaining closely connected with our patients. From the time you schedule your consultation, to your surgical procedure, to your ongoing follow-up appointments and calls, your care will be personalized and attentive.

Routine follow-ups may reveal:

  • Problems with the flow rate in the device
  • Problems connecting to the machine
  • Improper pressure

Fistula maturation and maintenance

Once the fistula is placed, it cannot be used right away. There is a three to six month waiting period which is often called “fistula maturation.” On the rare occasion that the fistula does not properly mature, our Interventional Radiologists will administer an x-ray with contrast dye to identify the problem. Once the x-ray reveals why the maturation did not take place properly, we will assist the process with a minimally invasive method of treating areas in the circuit, which may be narrowed to help with the maturation process.

Providing ongoing management

At VIVA, we persistently follow our surgical access patients. We have instituted a follow-up program specifically designed to connect with you on a regular basis. Over time, we can immediately address any problem with an immediate solution. These periodic check-ups will ensure that everything is working properly. Regular follow-ups also provide the opportunity to solve any potential issues before they become a bigger problem.

Contact us immediately if you are noticing any signs or symptoms of kidney failure such as:

  • Increased swelling
  • Infection
  • Fever
  • Tiredness

Plan your dialysis access management at VIVA.

If you are looking for a center for dialysis access placement and management in Fredericksburg, you’ll find the highest level of customized care at VIVA. Our attentive staff will be happy to assist you in scheduling an appointment. Call our office today: (540) 654-9118