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​Ladenheim Dialysis Access Centers (LDAC) is a multicenter practice that specializes in all aspects of managing access for dialysis for Central California.

Dialysis Access Evaluation

It is widely recognized that autogenous arteriovenous access is the preferred dialysis access of choice because of improved patency and low infection rate. It has been shown recently that preoperative ultrasound study to identify available venous conduits can increase the utilization of autogenous arteriovenous access.

At LDAC, Physicians will assess each patient for the treatment plan that works best for them. During evaluation the patient will have an ultrasound done of the veins in their arms. The doctor and patient will discuss options, when the access type is decided upon, an X-ray of the veins in the arms and chest will be done in our office and surgery can be scheduled.

Dialysis Access Creation

Physicians, Physician Assistants and Nurses at LDAC will review the best options for Accessing Hemodialysis. Physicians at LDAC are able to perform surgery at any of the Medical Centers in the Fresno area.

Arterio-Venous FISTULA - A surgeon creates an AV fistula by connecting an artery directly to a vein, frequently in the forearm. Connecting the artery to the vein causes more blood to flow into the vein.

Arterio-Venous GRAFT - If you have small veins that won't develop properly into a fistula, you can get a vascular access that connects an artery to a vein using a synthetic tube, or graft, implanted under the skin in your arm. The graft becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft doesn't need to develop as a fistula does, so it can be used sooner after placement. often within 2 or 3 weeks.

CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD) - Since the 1980's peritoneal dialysis has also been an option for those with ESRD. A CAPD catheter can be placed in your abdomen and you may be able to perform dialysis at home. LDAC will still remain as a partner in your health care team to continue to assess the patient and how the catheter is functioning.


After the Dialysis access is placed at LDAC we will check it on a regular basis and as needed, to determine how well it is working and/or if it is need of repair/intervention.

We see our patients on a routine basis and if there are any questions from the patient or family on the use, function or differences we will make sure to see them right away, to answer any questions.


Interventional procedures to assist the access can be performed at LDAC, most times within 24 hours.

  • Angioplasty
  • Thrombectomy
  • Stent Placement
  • Central Venous Access Placement
  • Fistulogram
  • Graftogram
  • Lipoplasty

Referrals are taken from all types of providers (Nephrologists, Hemodialysis Units, Home health care, General Surgeons) patients and family members/caregivers. When the access appears to not be working properly, call LDAC.


New technologies and developments are part of LDAC. We have an active Research program that works with Physician's, nurses, and scientists around the world looking for new ways to assist with promoting long term life of your Dialysis Access.