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Dialysis Access Institute

The Dialysis Access Institute (DAI) was established in 2011 by the foremost pioneer and world-renowned vascular access specialist John Ross, MD, FACS. Today, DAI is led by DAI Medical Director and access surgeon, Mark London, MD, FACS, who received his advanced surgical training in vascular access from Dr. Ross.

Dr. London and his team of experts treat patients experiencing end-stage renal disease. These leading surgeons specialize in obtaining, maintaining, and salvaging dialysis accesses using the latest techniques and technology to perform nearly 4,000 dialysis access related procedures and operations each year.

Interior view of operating room.The DAI is a unique, one-of-a-kind facility that has been designed specifically to promote excellent patient care in a very timely fashion, and with the best possible outcomes. The majority of patients leave DAI with same day vascular access or peritoneal access.

Procedures and operations offered at DAI include the following:

  • Percutaneous and open arterio-venous fistula placement
  • Arterio-venous graft placement
  • HeRO® graft placement
  • Percutaneous and laparoscopic peritoneal dialysis catheter placement
  • PleurXTM Catheter System placement for recurrent ascites
  • Temporary and permanent dialysis catheter placement
  • Repair and revisions of problematic accesses
  • Endovascular procedures including:

- Thrombectomy of clotted fistulas, grafts, and HeRO® grafts

- Angiogram and angioplasty procedures

- Treatment of central venous occlusion or stenosis

The DAI is accredited by the American Society of Diagnostic & Interventional Nephrology (ASDIN) as a hemodialysis vascular access training center. Accordingly, the DAI provides educational programs for physicians, nurses, and technologists regarding dialysis access, both on site and through live video streaming, so that best practices can continue to be developed and reviewed for the patients.

What is Dialysis Access?

Hemodialysis access allows patients with end-stage renal disease to be connected to a dialysis machine so their blood can be withdrawn, purified and returned to the bloodstream. Due to the large caliber needles used in dialysis and the frequency of dialysis treatments (about 3 times per week), the blood vessels through which access takes place must be prepared to withstand the rigors of frequent dialysis treatments. DAI offers the very latest dialysis access procedures, most common of which are the arteriovenous fistula, arteriovenous graft, catheter, peritoneal dialysis and the recently FDA-approved percutaneous arteriovenous fistula.

Arteriovenous Fistula

An arteriovenous (AV) fistula is created when an artery is connected directly to a vein. This allows blood to flow into the vein, causing it to grow larger and stronger so it can withstand repeated needle insertions for dialysis. Fistulas have proven to be beneficial for long-term dialysis because they can last longer and are less likely to become infected or clotted.

Percutaneous Fistula

The DAI was the first facility in South Carolina and one of just a handful in the country to offer this new, minimally invasive procedure. The creation of a percutaneous fistula minimizes recovery time and patients leave with a small Band-Aid over the incision site. The ease and convenience of this groundbreaking new option for dialysis access should improve the patient experience and enhance the quality of care for patients with end-stage renal disease. Percutaneous creation of arteriovenous AV fistulas can also be completed by interventional nephrologists, which will greatly increase the number of patients who receive the procedure.


If kidney disease has progressed quickly, you may need to have a venous catheter, which provides temporary access to the bloodstream for dialysis treatments. A catheter is a tube that is inserted into a vein in your neck, chest or leg. A catheter has two chambers that allow a two-way flow of blood so needle insertion is not needed. Catheters are not ideal for long-term access due to an increased risk of infection, but they can be used temporarily while a permanent access is being established.

Peritoneal Dialysis

Peritoneal dialysis (PD) is a treatment that uses the lining of your abdomen (belly area) called the peritoneum and a cleaning solution called dialysate to clean your blood. Dialysate absorbs waste and fluid from your blood using your peritoneum as a filter. The DAI uses the most advanced laparoscopic techniques to minimize catheter dysfunction.

Features of DAI

  • 16,000-square-foot facility
  • 6 Pre-op stations
  • 6 Post-op stations
  • 6 Operating/procedure suites (5 of which have live video streaming capabilities)
  • Digital radiology equipment
  • Hemodynamic monitors in each room
  • Spacious, comfortable waiting room
  • Covered canopies at both patient drop-off and ambulance entrance
  • Total emergency back-up power throughout the facility

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