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Treatment / AV Fistula Interventions

Fistula – Angioplasty, Stenting, Thrombolysis, Thrombectomy

A fistula is a passage from your kidney used to perform kidney dialysis. When there is decreased blood flow in a graft or fistula your physician may perform an angioplasty with or without the placement of a stent.

When is an intervention required?

When a graft or fistula becomes clogged or narrowed, it can prevent a patient from undergoing dialysis. An interventional radiologist can use minimally invasive image-guided procedures to restore blood flow.

Commonly performed interventions are:

  • Angioplasty – placing a small balloon in the graft and stretching the narrowed area open
  • Stenting – placing a small, metal-mesh tube to keep the narrowed area open
  • Thrombolysis – injecting medicine to dissolve the blood clot
  • Thrombectomy – physically removing or mashing up the blood clot

Some blockages are too difficult to open with catheters, balloons, or stenting. Surgery may be needed to bypass the blockage completely. If that is the case, a temporary dialysis catheter may need to be placed in a neck vein to allow you to receive dialysis until a surgeon is able to fix or revise your fistula or graft.

What to Expect from the Procedure

Angioplasty / Stenting

Angioplasty and stenting are minimally invasive procedure(s) where your vascular and interventional radiologist will use image guidance to direct a catheter to the site of the blockage. Once the catheter is in place, contrast dye will be injected and x-rays will be taken of the blocked vessel to help identify the exact site of the blockage.

A small balloon will be directed to the area of the blockage and inflated for a short period of time. Depending on the extent of the blockage the same site may be repeatedly treated with the same balloon, a different balloon, or the balloon may be moved to other sites.

Additional x-rays will be taken to determine how much the blood flow has improved.

Frequently, angioplasty procedures also include the placement of a stent, a small flexible wire mesh. A stent will be placed and expanded with a balloon. When the balloon is deflated and removed, the stent will remain in place permanently to hold open the vessel and restore blood flow.

Thrombolysis / Thrombectomy

When blood does not flow smoothly, it can begin to coagulate, turning from a free flowing liquid to a blood clot or thrombus. When blood clots in a fistula or graft and prevents a patient from receiving dialysis, thrombolysis or thrombectomy can be performed.

Thrombolysis is a minimally invasive treatment where your vascular and interventional radiologist will use image guidance to direct a catheter to the site of the blockage. Once the catheter is in place, a clot-dissolving medication will be delivered through the catheter over several minutes.

Thrombectomy is a minimally invasive treatment where your vascular and interventional radiologist will use image guidance to direct a catheter to a site of the blockage. Once the catheter is in place, a mechanical device will be deployed at the site to break up the clot.

Recovery

These procedures are typically performed as an outpatient procedure and lasts about an hour. Afterwards you will rest in a recovery area for a while before you are sent home or to dialysis.

Most patients can resume normal activities the next day; however you should avoid lifting heavy objects and strenuous exercise for at least 24 hours. If you notice any signs of pain or bleeding where the catheter was inserted, you should lie down and apply pressure to the site and call your physician.

For more information or to schedule an appointment, please call IVC at 503-612-0498. You can also read our brochure on Kidneys and Dialysis.

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