What will I experience during and after the procedure? Who interprets the results and how do I get them? What are the benefits vs. In order for a person to undergo dialysis, a physician first creates access to his or her blood vessel using one of three methods: a fistula, which is made by joining together an artery and vein to make a bigger high-flow blood vessel. When fistulas and grafts become clogged or narrowed, which can prevent a patient from undergoing dialysis, interventional radiologists use image-guided interventions to fix the problem: Catheter-directed thrombolysis , which dissolves blood clots that build up in fistulas and grafts by injecting a medicine.
Catheter-directed mechanical thrombectomy , where the clot is physically removed or mashed up. Angioplasty and vascular stenting , which use mechanical devices, such as balloons, to open fistulas and grafts and help them remain open. After the balloon is removed, a small wire mesh tube called a stent may be implanted to keep the fistula or graft open if angioplasty alone fails.
These procedures are used to treat: Narrowing of dialysis fistula or grafts: When there is decreased flow in a graft or fistula, angioplasty or angioplasty with vascular stenting may be performed. Thrombosis of dialysis fistulas or grafts: When blood does not flow smoothly, it can begin to coagulate , turning from a free-flowing liquid to a semi-solid gel, called a blood clot or thrombus.
Angioplasty or angioplasty with vascular stenting may also be performed in this setting. Tell your doctor about recent illnesses or other medical conditions. The nurse will give you a gown to wear during the procedure. The blood clot will then be dissolved in one of two ways: by delivering medication directly to the blood clot thrombolysis. You will lie on the procedure table. The doctor will make a very small skin incision at the site.
The doctor or nurse will remove your IV line before you go home. Your interventional radiologist may recommend a follow-up visit. Benefits No surgical incision is necessary—only a small nick in the skin that does not need stitches. Angioplasty and Vascular Stenting: These procedures are performed using local anesthesia or conscious sedation; no general anesthetic is required in the majority of patients.
You will be able to return to your normal activities shortly after the procedure. Catheter-directed Thrombolysis: Catheter-directed thrombolysis can greatly improve blood flow and reduce or eliminate the related symptoms and effects without the need for more invasive surgery.
Thrombolysis is a safe, highly effective way of re-establishing circulation blocked by a clot. Thrombolysis is less invasive than conventional open surgery to remove clots and the hospital stay is relatively brief.
Blood loss is less than with traditional surgical treatment and there is no obvious surgical incision. Risks Any procedure that penetrates the skin carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1, There is a very slight risk of an allergic reaction if the procedure uses an injection of contrast material.
Any procedure that places a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. The doctor will take precautions to mitigate these risks. Angioplasty and Vascular Stenting Major complications following angioplasty are uncommon.
However, inserting the catheter can lead to injury of the artery or vein. The balloon also poses a risk of blood clots or tearing the artery or vein. When angioplasty is performed, blockages can recur, although most of these arteries can be opened again successfully. This can also occur when a stent is placed in the artery at the time of the angioplasty.
Heavy bleeding from the catheter insertion site may require special medications or a blood transfusion. A relatively rare complication associated with balloon angioplasty is abrupt vessel closure, or occlusion. This blockage in the area treated by the balloon angioplasty typically occurs within 24 hours of the procedure. If it happens, treatment with medication into the vessel to dissolve clots followed by angioplasty or stenting may be appropriate. In some cases, emergency bypass surgery may be needed.
Other rare complications include heart attack and sudden cardiac death. Contrast material used during these procedures may cause renal failure, a decrease in kidney function, particularly if there is already some degree of decreased kidney function.
There is a risk of damage to the fistula or graft. A fistula is created by joining a section of an artery and a vein to make one large vessel capable of handling high volumes of blood during hemodialysis. But maintaining any access site is a major clinical challenge. Blood clotting in the fistula is the most frequent cause of early fistula failure. Clotting, infection and low blood-flow rates in the access site are common reasons for hospitalizations requiring multiple treatments or surgeries.
The Dialysis Access Consortium DAC found that only 12 percent of patients developed blood clots in the fistula when treated with the clot-preventing drug clopidogrel, compared to nearly 20 percent of patients treated with placebo. Nevertheless, about 60 percent of new fistulas in each group could not be used for long-term dialysis treatments.
A large untreated arteriovenous fistula can lead to serious complications. Your doctor monitors your arteriovenous fistula if you have one for dialysis. Small arteriovenous fistulas in your legs, arms, lungs, kidneys or brain often won't have any signs or symptoms and usually don't need treatment other than monitoring by your doctor. Large arteriovenous fistulas may cause signs and symptoms. A significant arteriovenous fistula in your lungs pulmonary arteriovenous fistula is a serious condition and can cause:.
An arteriovenous fistula in your gastrointestinal tract can cause bleeding in your digestive tract. If you have any of these signs and symptoms and think you might have an arteriovenous fistula, make an appointment to see your doctor.
Early detection of an arteriovenous fistula may make your condition easier to treat. It also may reduce your risk of developing complications, including blood clots or heart failure.
In addition to certain genetic or congenital conditions, the following risk factors may make you more likely to develop an arteriovenous fistula:. Left untreated, an arteriovenous fistula can cause complications, some of which can be serious. These include:.
Author: Healthwise Staff. Medical Review: Anne C. PeaceHealth endeavors to provide comprehensive health care information, however some topics in this database describe services and procedures not offered by our providers or within our facilities.
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Skip to main content. Health Information Library. Vascular Access Failure. Topic Overview Dialysis is a lifesaving treatment when you have kidney failure. Call your doctor right away about any signs of trouble. Make a habit of talking with your dialysis nurses and doctor about how well your access is doing. What are the options for hemodialysis access? Permanent access There are two permanent access types: An arteriovenous AV graft is made by inserting a small tube between an artery and a vein, usually in the upper arm or forearm.
A graft is a good choice if you have small veins or other problems. It can sometimes be used as soon as 1 week after placement.
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