Surgery to connect an artery and a vein is called a fistula. Usually this is done so that there is enough passage for blood to flow effectively during hemodialysis. The process of removing blood from an artery in a kidney patient, purifying it by dialysis, adding vital substances, and returning it to a vein is called hemodialysis.
When a person has repeated hemodialysis over a long period of time the lining of the blood vessels can overgrow and narrow to the point that hemodialysis becomes difficult. Blood clots and blockages can form, too.
A fistulagram is a procedure done by a radiologist using X-ray to locate the places where the vessels are narrowed or blocked. It’s quite common, if narrowing is found, for the radiologist to do a balloon angioplasty right after the fistulagram.
A balloon angioplasty involves putting a balloon-tipped, small plastic tube into the narrowed blood vessel and then inflating it forcing open the narrowing so more blood can flow.
Preparation for the procedure
You must not eat or drink anything for four hours before the fistulagram.
Tell your doctor about all of the medications you are taking including herbal preparations, insulin, blood thinners including coumadin or aspirin and glucophage. Your dose may need to be adjusted.
You will be asked to sign a consent form after the procedure has been explained to you.
Tell the doctor if you suspect that you may be pregnant.
Arrange for someone to drive you home after the procedure.
How is it done?
You will lie on an X-ray table.
An IV will be started.
You’ll be given medication to help you relax.
You will have a clip on your finger to monitor your oxygen intake.
Your heart rate and blood pressure will also be monitored throughout the procedure. An EKG monitor will be used.
Your skin will be scrubbed with antiseptic and you will be injected with lidocaine.
You will have dye injected through a needle access of your fistula. Then a series of X-rays will be taken
The balloon-tipped catheter will be inserted into the fistula over a guide wire and you may be given a blood-thinning injection. Dye will also be injected. X ray photographs will be taken of the site after the initial balloon procedure to determine a good result or the need for a second balloon procedure with a larger balloon.
How long you will be at the hospital depends on how difficult it is to find the blockages and insert the catheter. The procedure takes 45 to 90 minutes and then at least 30 minutes of recovery time at the hospital.
What equipment is used?
There will be a blood pressure cuff to monitor your blood pressure. You will be attached to an EKG machine so that your heart can be monitored. There will also be an X-ray machine that can be moved around. Various catheters and guide wires will be used to perform your procedure to provide visual guidance for the doctor.
How will it feel?
You may feel some stinging when the local anesthetic is applied. You may feel a painful pinching sensation when the balloon is inflated.
What are the risks and benefits?
Having a fistulagram can help prevent problems with your dialysis and contribute to improved treatment. It can extend the life of a fistula.
Risks include potential damage to a vessel to the extent that a metal stent or surgical intervention is needed. Fistulas are only functional for limited period of time and there are a limited number of places where they can be placed.
Who interprets results and how will I get them?
The interventional radiologist will review the pictures. If there is a narrowing of the fistula or a clot a balloon angioplasty may be done right away.
After the procedure
A nurse will check your vital signs and apply pressure to the site where the catheters were inserted to stop bleeding. After a while you will be able to go home.
You will need someone to drive you home.