What is a dialysis fistula (graft intervention)?

There are two types of permanent vascular access for dialysis: arteriovenous (AV) fistula and arteriovenous (AV) graft. A surgeon creates an AV fistula by connecting an artery directly to a vein, most commonly in the forearm. Alternatively, a surgeon creates an AV graft by connecting an artery to a vein using a synthetic tube or graft.

Sometimes the blood flow from an AV fistula or AV graft becomes too low due to a narrowing, a blood clot, or the formation of a collateral (accessory) blood vessel that is diverting blood flow.

An interventional radiologist can correct these problems with fistula intervention or graft intervention.

Procedure                                                        

Using live X-ray (fluoroscopy) for guidance, the doctor will insert a catheter (a tiny tube) into a vein or artery, usually in the arm or leg, and guide it to the fistula or graft.

For a narrowing, the doctor will thread a small, deflated balloon through the catheter into the narrowing and then slowly inflate the balloon to widen the narrowing. Sometimes more than one balloon is used.

For a blood clot, the catheter will be connected to a small machine that sprays a saline solution onto the clot to break it up, and then suctions out the pieces of the clot. The procedure may need to be repeated.

For a collateral blood vessel, the doctor will thread a tiny metal coil through the catheter and place it in the vessel. This will block blood from flowing into the collateral blood vessel, restoring the full flow of blood into the graft or fistula. Sometimes more than one coil is placed.

Risks

The procedure is considered low-risk. However, potential complications include:

• bleeding
• infection
• injury to the artery and/or vein
• contrast reaction (allergic reaction to X-ray dye)
• pulmonary embolus (blood clot in the lung)

Anesthesia

Patients receive either IV sedation or general anesthesia and are asleep for this procedure.

After the Procedure

Your child will be taken to a recovery room and in some cases may be admitted to the hospital for observation. Your child might have some mild discomfort; you may give over-the-counter pain medication if permitted by your primary physician.

Bathing

The bandage must stay dry and in place for 48 hours. You may sponge bathe your child during this time, as long as the bandage stays dry. After 48 hours you may remove the clear bandage and gauze and your child can take a shower or take a bath, as long as the site isn’t immersed in water. Leave the Steri- Strips® (white strips) in place. Do not immerse the site in water until the Steri-Strips fall off. If they haven’t fallen off after seven days, you may remove them.

Activity Restrictions

Your child may return to normal activity as tolerated.