A guide to your fistulogram or fistuloplasty What is a fistulogram? It is an x-ray examination to see if there are any blockages or narrowings in your fistula. What is a fistuloplasty? It is a non-surgical procedure used to open up blocked or narrowed vessels in your fistula arm. This is done to improve the function of your fistula. Why do I need a fistulogram? Your fistula or graft allows you to have effective dialysis. However, problems can arise that indicate there is a problem with the anatomy of the fistula. You or the nurses may find it difficult to place the needles, the flow through the fistula may be reduced (either the pump speed or the measurements taken on the unit may indicate this) or your dialysis quality may be below the recommended standard. Other problems may be related to clots, excessive bleeding or swelling of the limb on the side of the fistula. Since these problems may indicate an anatomical problem, carrying out a fistulogram allows us to demonstrate that, and potentially correct the problem. This leaflet will explain what we mean by a fistulogram, how it is carried out, how you are looked after during and after the procedure and what are the risks. What alternatives are there? Some anatomical abnormalities of the fistula can be repaired surgically, but a fistuloplasty has less risk, and requires less time to carry out. Detailed analysis of the anatomy of a fistula does require a fistulogram, although ultrasound can give some information. Finally, leaving a problem alone risks the loss of the fistula or graft, and the need for catheters (lines) and further surgery. How are fistulograms and fistuloplasties performed? You will either come directly from home or the renal ward to the X-Ray Department at the Royal Derby Hospital. You will be awake during the procedure. A fistulogram involves the placement of one or more plastic tube(s) (catheters) into your dialysis fistula or the artery feeding into the fistula. The skin over the graft/fistula will be numbed with local anaesthetic before the catheter is inserted. X-ray contrast material (x-ray dye) will then be injected through the catheter and x-ray pictures taken. You may be asked to hold your breath for several seconds as these pictures are taken. During the injection of x-ray contrast material, you may experience a warm feeling or a strange taste in your mouth. Both of these sensations are temporary and will go away quickly. If the fistulogram shows an area of narrowing or blockage, a fistuloplasty may be performed. This involves the insertion of a special tube that has a tiny deflated balloon at its tip. The balloon is positioned at the site of the blockage and is then inflated and deflated several times. If you experience any discomfort during the inflation of the balloon, you will be offered pain relief. Sometimes, if there still is not enough blood flow through the area despite fistuloplasty, a metal mesh tube (stent) may be placed at the site. The stent will widen the vessel and improve the blood flow. If the fistulogram shows that a blood clot is blocking one of your vessels, a special drug or mechanical device may be used to dissolve or remove the clot (Thrombectomy/Thrombolysis). At the end of the procedure, the catheter will be removed. Sometimes a stitch will be placed at the puncture site to stop the bleeding. This will be removed by the nurse at your next dialysis session. How do I get ready? It is very important that you tell the staff in the X-Ray Department (or the staff in the Renal Dialysis Unit) if you are taking Warfarin or Clopidogrel (Plavix). Telephone 01332 783215 for further advice. These drugs thin the blood, so please let us know in advance to prevent last minute cancellations of your procedure. You will be able to eat a light breakfast/lunch before the fistulogram. If you are diabetic please continue with your normal routine and diet. Tell the doctor if you are pregnant or if you have any allergies. Who will do the fistulogram or fistuloplasty? One of the renal doctors will explain the procedure to you beforehand in the clinic or on the renal unit/ward and then ask you to sign a consent form. A radiologist (a doctor who specialises in x-ray procedures) will perform the examination. How long will the procedure take? You will be given an appointment time for your fistuloplasty or fistulogram. The procedure will take about 30 - 60 minutes. You will then need to stay in the department for between 30 minutes and 2 hours so we can check on you (depending on which procedure has been performed). What happens after the procedure? You will be monitored for a period of 30 minutes for fistulograms and up to 1 - 2 hours for fistuloplasties. We will check your blood pressure, heart rate and puncture site frequently during this time. You may eat and drink. We will show you how to apply pressure to the fistula if any bleeding should occur at home. Are there any possible complications from having a fistulogram or fistuloplasty? Complications are uncommon but may occur despite the precautions we take. These include: 1. Allergy to the dye injected during the fistulogram (this occurs in less than 1 in 1000 patients). 2. The dye that is injected into the fistula can cause a further reduction in your kidney function if you have any residual kidney function. 3. Pain or discomfort at the catheter insertion site. 4. Bleeding and bruising at the catheter insertion site. 5. Infection which may result in an infection of the blood stream. 6. Injury to a blood vessel may cause damage or failure of the fistula, or may reduce blood flow to the arm/leg. This may require urgent surgery to correct. Care at home Call the renal unit or go to the Accident and Emergency Department, should any of the following occur: • Any bleeding from the puncture site (other than very minor bleeding which stops quickly with pressure). • Large amounts of bruising or swelling. • Severe pain at the procedure site, or if your arm/leg becomes pale, painful or cold. • Fevers or chills, or a high temperature. • Pus at the puncture site. • A lump at the puncture site. • Chest pain, or if you notice difficulty in breathing. • You are unable to feel the thrill or buzz in your fistula. Reference Code: P0313/1478/07.2010/VERSION1 © Copyright 2010 All rights reserved. No part of this publication may be reproduced in any form or by any means without prior permission in writing from the Patient Information Service, Derby Hospitals NHS Foundation Trust.