Fistuloplasty For Hemodialysis Fistula!

A fistula connects an artery to a vein, and is the blood vessel which is used for kidney dialysis. A graft is a tube that connects an artery or a vein artificially and is used for dialysis in case a fistula can’t be created.

An arteriovenous fistula is best able to access the blood stream for long-term hemodialysis and is created by connecting the artery to a vein, usually in the wrist or upper arm. It helps to transfer blood into a dialysis machine and back again during the procedure.

A fistulogram helps examine the problems inside the fistula like blockage or narrowing and involves taking X-Ray pictures of it by injecting dye into the graft or fistula. Fistuloplasty is a way of treating too narrow fistula or graft in which the fistula is inserted with a small balloon that is inflated resulting in stretching the fistula or graft, thus making it easier for blood flow. A Fistuloplasty is generally performed with a fistulogram at the same time by an interventional radiologist.

Why is Fistuloplasty Needed?

When there is a problem of narrowed or blocked fistula or graft, a fistulogram and Fistuloplasty is recommended. A narrowed fistula makes placing needles for dialysis, can prevent the smooth working of the dialysis machine or can cause complete blockage of the fistula. A narrowed fistula prevents its proper development. Also, the aging of the fistula decreases its effectiveness and function.

A treatment might not be possible if there is some problem with the fistula. A new fistula is too underdeveloped to be used for dialysis. If there is complete blockage but regular dialysis is required, a dialysis catheter or permcath is required to be inserted into the neck, which has a higher risk of complications.

Alternative:

The problems with fistula or graft can be diagnosed with an ultrasound scan, but its treatment is not possible. The main alternative to Fistuloplasty is forming a new fistula through surgery. But, it is advisable to preserve and make it possible to function with the older fistula as long as it can perform because there are only limited blood vessels in the body which are suitable to form fistulas.

The Procedure:

1. The patient lies on the back of the X-Ray table. Heart rate and blood pressure are monitored. Oxygen masks might be required in some cases.

2. The radiologist looks at the fistula with an ultrasound scanner.

3. The skin over the fistula is cleaned with an antiseptic fluid and the patient is covered with a sterile sheet.

4. A local anesthetic is then inserted near the fistula to make skin numb.

5. A small catheter is then placed into the fistula into which an X-Ray dye is injected for taking pictures of the fistula.

6. When a Fistuloplasty is needed, a fine tube is threaded through the catheter into the fistula with a balloon at its tip.

7. The balloon is inflated to stretch the fistula which might be uncomfortable but short-lasting.

8. Rarely, a metal support called a stent is put inside the fistula, which is permanently helping the fistula stay open.

9. When the Fistuloplasty finishes, the catheter and the balloon tube are removed. The small hole will be closed with stitches.

Take Away:

Hemodialysis fistulas can be defined as surgically created connection between an artery and a vein. A fistulogram and Fistuloplasty is generally a safe and quick way to find and treat problems with dialysis fistula or graft.