Hemodialysis Access Repair - Fistulagrams

What is hemodialysis?
Hemodialysis is a procedure in which a machine filters harmful waste and excess salt and fluid from your blood. A needle is inserted into your arm through a special access point. Your blood is then directed through the needle to a machine called a dialyzer, which filters your blood a few ounces at a time. The filtered blood returns to your body through another needle.

What is a fistula?
A fistula is a surgical connection between an artery and a vein. The fistula is created to provide enough blood flow at the appropriate pressure to make hemodialysis effective and possible.Fistulagram is an x-ray study of your fistula. This procedure can detect problems such as a clot or narrowing of the vessels. Early detection and treatment can improve your fistula’s performance and limit future complications.You may be having symptoms that suggest a blockage of your fistula, for example:

  • A blockage in your fistula may cause high venous pressures during your dialysis.
  • If you cannot feel a thrill with your fistula, the fistula may be completely blocked.

The blood vessels that are connected to the fistula are subjected to higher rates of blood flow and pressure. Often, this results in the formation of scar tissue, causing narrowing of the fistula or blood vessels. A fistulagram can identify exactly where the artery or vein is blocked, how severe the blockage is, and what is causing the blockage. 

What happens during the procedure?

Conscious sedation is provided just prior to starting the procedure. You will be asked to lie on the x-ray table and will be connected to several types of monitoring equipment. The technologist will prepare the skin over the fistula by cleaning it with an antiseptic solution and placing sterile drapes and towels over you to create a sterile work space.

Lidocaine local anesthesia is injected into the skin. The radiologist will
insert a needle into your fistula and inject contrast (x-ray dye) to enhance the images. You may feel warmth in your hand, arm, and chest, and may get a metallic taste in your mouth. These feelings will last 10-15 seconds.
These pictures are reviewed by the Interventional Radiologist and, if necessary, the findings discussed with your referring doctor.  If there is an area of narrowing or clot present in the blood vessel that can be helped by balloon angioplasty, stent, clot dissolving medications, or a clot breaking device, this may be done at this time. 

Angioplasty is the inflation of a balloon inside the narrowed area of a blood vessel.  Occasionally a second needle must be placed in another part of the fistula in order to perform angioplasty.   A plastic tube with a balloon attached is positioned at the level of narrowing. The balloon is inflated several times. You may feel pressure due to the stretching of the vessel. The goal is to make the vessel opening bigger and allow for better blood flow. Whenever the angioplasty (balloon) alone ids not enough to improve blood flow, a stent may be placed at the site of the narrowing.

The catheter is removed and pressure is applied over the vein until there is no bleeding (approximately 5min.). You may need sutures to close the site. If you do, your Dialysis nurse will remove them on your next dialysis session.

This procedure typically requires 1-3 hours depending on what needs to be done to ensure a workable fistula for dialysis.

What happens after the procedure?
Following the procedure patients are required to remain on bed rest and be monitored for signs of bleeding at the vein puncture site and ensure that the sedation has worn off.

Going home:

  1. You should plan to have someone drive you home after the procedure as you may have received sedation medication, which may cause you to be drowsy.  You should not operate any machinery or drive for 24 hours.
  2. Try to avoid any lifting, especially heavy objects, for the rest of the day.  If you notice any swelling, oozing or brisk bleeding from your fistula, IMMEDIATELY apply direct pressure to the areas for 10 minutes.  Slowly release the pressure and check to see if the bleeding has stopped.  Repeat the process once if necessary.  If the bleeding does not stop at this point, seek emergency assistance by calling 911.
  3. You may resume all of your normal dietary and medication requirements.
  4. Resume your normal dialysis schedule.

If you have any questions or need to reschedule an appointment please feel free to contact the Interventional Radiology Office at 802- 847-8359. Our business hours are Monday – Friday 8:30 a.m. to 5 p.m. Someone is available to take your call after hours for emergencies.

This information is provided by the Fletcher Allen Health Care, Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.