Fistulogram fistuloplasty

An AV (arteriovenous) fistula is a surgical connection between an artery and vein created for haemodialysis. It helps to transfer blood into the dialysis machine and back again during haemodialysis. A Fistulogram is a procedure that looks at the vessels of the fistula in detail to see if there are any problems with it. A Fistuloplasty is when a fistula has become blocked or narrowed and it needs to be treated by stretching the fistula with a balloon.

A Fistulogram is used to assess the fistula by taking detailed pictures of the fistula to see if any further treatment is required.

A Fistuloplasty is a procedure used to treat the fistula if there are any narrowings or blockages. The fistula can age and problems such as scarring, clots or a decrease in function or the effectiveness of dialysis can occur. If these issues aren’t treated then your fistula can stop working completely.

The Consultant in charge of your case, and the Interventional Radiologist (the doctor who specialises in Imaging Procedures) who will be carrying out the Fistulogram/Fistuloplasty will have discussed the situation, and feel that this is the best option.

However, you will also have the opportunity for your opinion to be taken into account and if, after discussion with your doctors, you do not want the procedure carried out, you can then decide against it.

A specialist doctor called an Interventional Radiologist. Interventional Radiologists are experts in using X-ray equipment and in microsurgical techniques.

In the Imaging Department, in a special Interventional Radiology (IR) Procedure Room which is designed for these specialised procedures. You will be checked into the department by a nurse, who will ask some medical questions and fill out some paperwork. The Interventional Radiologist will then come and talk to you about the procedure, and you will have the opportunity to ask any questions or raise any concerns. Only if you are happy to continue with the procedure will you be asked to sign the consent form.

It is performed in the IR procedure room, where you will lie on your back on a special x-ray table and be covered with sterile drapes.

• The interventional radiologist will usually start by looking at your fistula using an ultrasound machine. The area will be cleaned and you will have local  anaesthetic injected to numb the area.
• A small needle is inserted into your fistula and a wire is passed through the needle. The needle is removed and a small plastic tube is inserted.
• X-ray dye is then injected to see all of the vessels of the fistula (this is the Fistulogram).
• If a Fistuloplasty is required a small catheter is passed through the fistula and into the blockage. Then the catheter is taken out and a balloon is inserted. The balloon is then inflated for a few minutes, deflated and then removed. This will stretch the blood vessel and should relieve the blockage. This may need to be done a few times, to ensure the narrowing has been treated.
• Once the radiologist is finished the catheter will be removed and the radiologist will either press on the puncture site or place a stitch.

To prepare for the procedure you will need to make sure you do the following:

You will need to have a blood test before your procedure. Please let us know if you are taking any antiplatelet medicines (for example, Aspirin, Clopidogrel) or any medicines that thin the blood (for example, Warfarin), as these may need to be stopped temporarily before the procedure. Call the IR department for advice as soon as
you get your appointment letter on 01273 696955 Ext. 4240/4278 and ask to speak to one of the IR nursing team.

If you are taking medicines for diabetes (for example metformin) or using insulin, then these may need to be altered around the time of the procedure. Call the IR department on the numbers above for advice as soon as you get your appointment letter.

You cannot eat or drink anything (except water) for four hours before your procedure. You can drink water up to two hours before your procedure.