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Having a vascular fistulogram and or fistuloplasty
What is a fistulogram?
This is a test in which X-ray contrast (dye) is injected into your fistula. The test gives information about the veins and artery of your fistula or graft, a bit like a map. The test helps to show any narrowing, or blockage in the blood vessels of your fistula.
What is a fistuloplasty?
Once a narrowed vein or artery in your fistula has been identified, a wire is inserted and then a balloon is passed over the wire and the balloon is inflated. This balloon stretches the narrowing in your vein or artery.
You will be asked to lie on the X-ray table with your fistula arm out to the side. You may get some discomfort in the area where the vessel is being stretched. This is normal and usually stops when the balloon is let down.
At the end of the procedure the doctor will either stitch the hole closed, or apply firm pressure to the site for about 10 minutes.
Who does the procedure and where is it conducted?
The procedure is conducted in the Angiosuite of the Department of Medical Imaging by a Radiologist or a Vascular Surgeon.
Other important information
You should take all of your usual medications before the operation, including aspirin.
- Discomfort; bruising: Occasionally slight discomfort, pain or a small bruise at the needle site may occur.
- Bleeding: Sometimes the needle puncture site may bleed for a prolonged period of time. If bleeding occurs at home, apply pressure with a clean cloth. This usually settles, but if bleeding is excessive or continues beyond 15 minutes, call an ambulance.
- Sometimes whilst stretching the fistula with the balloon, a small tear on the vessel wall may occur, or even less often, the fistula may rupture. This may require a further procedure or operation.
- Infection: If there are any signs of infection, such as; redness, discharge, pain, swelling or you feel unwell, see a doctor immediately in the hospital emergency department.
- Reaction to X-Ray contrast (dye): Some patients can have a reaction to the X-Ray contrast (dye) used during the procedure. In most cases, this is a very mild reaction such as a skin rash but occasionally it can be life-threatening. It is important that you tell the nursing or medical staff if you feel unwell after the procedure or if you have a rash.
- Kidney function and contrast (dye): Occasionally the contrast (dye) may reduce kidney function. Your Nephrologist can explain this further to you if you are concerned.
- The procedure does not work: Occasionally the narrowing in the fistula may persist after the balloon is let down.
- Itching at the needle site: Itching is usually due to healing. It is very important not to scratch or pick off the scab that forms over the needle site, as this may cause serious bleeding.
How long will I be in hospital?
These procedures are usually performed as a day case, meaning you can go home the same day as the procedure. It will not be safe for you to drive, so you will need to have someone to pick you up and take you home after the procedure. You should also have someone stay with you that night in case you become unwell.
Where do I go and do I need to fast?
The Medical Imaging Nurse will call you at home and let you know the time to arrive and where to go. The nurse will also let you know what time to fast. You may continue to drink water up to the procedure, however no food after the fast time.
What do I need to tell the medical imaging nurse when I am called?
Please tell the nurse if:
- You have diabetes or are on a medication called Metformin.
- You are taking blood thinning medications, such as Warfarin, Clopidogrel (Plavix) or Xarelto (Rivaroxaban). These drugs may need to be stopped before the procedure.
- You have had a reaction to contrast (dye) in the past.
After transfer to the ward, you will be required to stay in the hospital for about 2 hours for observation.
After you go home, please keep your dressing dry. Your Radiologist or nurse will let you know when the dressing can be removed and you can then bath or shower as normal. If you have stitches (sutures), your Radiologist or Surgeon will leave instructions about when your sutures can be removed. The staff in the renal unit can remove these sutures.
