What is a Dialysis Shunt Fistulagram And Fistula Maintenance?
A dialysis fistula is a surgically created connection between an artery and a vein. This is done to provide enough blood flow at the appropriate pressure to make hemodialysis effective and possible.
The blood vessels in the fistula are used frequently. Because of the rigors of hemodialysis, they are put through more trauma than other vessels in the body. The lining of these vessels are subjected to higher rates of blood flow and pressure, in addition to the trauma of multiple needle insertions. Often, the response to this repeated strain is the overgrowth of the lining of the vessel. This results in the narrowing of the fistula vessels. A fistulagram is designed to detect these narrowed areas by x-ray.
What Is A Fistulagram?
A fistulagram is a special procedure performed in the Radiology Imaging Department. With the use of x-ray dye, the blood flow through your fistula will be evaluated. The procedure can detect problems such as a clot or narrowing. Early detection and treatment of problems with your fistula can improve its performance and limit future complications.
Who Will Perform My Fistulagram?
An Interventional Radiologist, a doctor specially trained in the study of the vessels of the fistula, will perform the test.
What Is Fistula Angioplasty?
If a narrowed area is found in the fistula you may require balloon angioplasty. Angioplasty is the inflation of a balloon inside the blood vessel at the area in which it is narrowed. The inflation of the balloon redistributes the extra material inside the blood vessel against its walls. This makes the vessel opening bigger and allows for more blood flow.
Angioplasty to the fistula is often performed immediately following the fistulagram portion of the test. Usually through the same needle, a small plastic tube with a balloon attached is positioned at the level of the narrowing. The balloon is inflated, sometimes repeatedly, and x-rays are taken. Most patients do not feel the balloon inflation. Others experience several seconds of pressure in the fistula. Sometimes a second needle must be placed in another part of the fistula in order to perform the angioplasty.
When angioplasty is completed, the needle(s) are removed and pressure is applied to the fistula as it is after dialysis. A brief period of observation following fistula angioplasty may be required.
Is There Any Preparation for the Test?
There is usually minimal preparation before the test. Some patients may be asked to limit food or drink for a time before the test and/or make adjustments in their medications. Your dialysis staff will be able to help you with specific instructions.
Points to remember:
- Fistulagram detect narrowed areas in the blood vessels.
- Narrowings are made wider with balloon angioplasty
- A good thrill in your fistula is one sign of good blood flow through the exit portion or vein of your fistula.
- A good pulse in your fistula is one sign of good blood flow through the entrance portion or artery of your fistula.
- Monitor your fistula frequently.
- You will be one of the best people to evaluate how well your fistula is working by knowing the characteristic thrill and pulse of your fistula. Note any changes to your physician and/or the hemodialysis staff.