Hemodialysis patients can develop problems with their arteriovenous (AV) fistulas or grafts. To diagnose and treat these problems, doctors usually refer patients to a fistulogram. This minimally invasive procedure checks blood flow in your AV fistula or graft to determine if there are any abnormalities. At Vascular and Interventional Partners in Scottsdale, AZ, our doctors are trained and experienced in performing AV Fistulograms and treating any existing issues.
What Is an AV Fistulogram?
An AV fistulogram, also called a dialysis fistulogram, is a special X-ray procedure that can detect abnormalities in blood flow in and around your dialysis access. Abnormalities in blood flow can indicate problems that may interfere with your hemodialysis treatment and lead to complications, such as:
- Narrowing (stenosis)
- Blockage (occlusion)
If your fistulogram test shows any of the above, your doctor may perform an intervention, such as angioplasty, stent placement, thrombolysis or thrombectomy. These can be performed at the same time as your AV fistulogram or at a later date.
An AV fistulogram is a minimally invasive procedure usually performed under local anesthesia in an interventional radiology suite. The procedure is performed using thin catheters, contrast dye and X-ray image guidance and takes two to three hours to complete. Most patients can resume their normal activities the next day.
an AV Fistulogram
An AV fistulogram is a safe and effective way to diagnose and treat common problems with dialysis access. Benefits include:
- Less invasive than surgery
- Few or only mild side effects
- Real-time imaging that makes immediate treatment possible
- Provides clear images of the dialysis access
- Improves dialysis outcomes
Choosing Vascular and Interventional Partners for Your AV Fistulogram
An AV fistulogram can help ensure that your fistula or graft functions for a long time, reducing your need for repairs, revisions or alternatives. Having your AV fistulogram performed by a skilled and experienced specialist is important in ensuring your dialysis access remains functional.
Vascular and Interventional Partners is Arizona’s most respected interventional radiology division in the state. Our five fellowship-trained doctors are board-certified by the American Board of Radiology in interventional radiology and/or diagnostic radiology. All have extensive experience performing routine AV fistulograms and treating complex occlusions, stenoses and other problems that can happen with dialysis access. They are also active members of several professional organizations and are involved in research.
Frequently Asked Questions
Why do I need an AV fistulogram?
For hemodialysis patients, hemodialysis access is a lifeline. It needs to function properly for your treatment to work. If your doctor suspects problems with your hemodialysis access, they may refer you for a fistulogram.
Signs there may be issues with your dialysis access include:
- Inconsistent or no bruit (vascular murmur)
- Change in fistula thrill (vibration or pulse)
- Change in sensation (numbness, tingling and cold)
- Prolonged bleeding (more than 15 minutes)
- Arm or hand swelling
These symptoms are often the first signs that something is wrong with your AV fistula or graft. Getting an AV fistulogram can help find the causes of these symptoms on time and provide an opportunity for immediate treatment.
Before the advent of interventional radiology, salvaging AV fistulas meant further surgery and long recovery times. An AV fistulogram makes it possible to correct existing problems without incisions and stitching.
How should I prepare for my AV fistulogram?
You will be provided with instructions on how to prepare for your AV fistulogram at Vascular and Interventional Partners. Most of our patients are required to do the following in the days leading up to their appointment:
- Adjust certain medications (e.g. blood thinners, insulin and metformin)
- Stop taking pain relievers that thin the blood (e.g. aspirin and Ibuprofen)
- Disclose any allergies, especially to contrast dye
- Inform us if there is any chance you might be pregnant
- Do not drink or eat anything eight hours before your procedure
- Bring all your medication and a list of medications you take with you
It’s also a good idea to arrange for someone to drive you back home as anesthesia can take a while to wear off. You should also wear loose-fitting and comfortable clothing.
What should I expect from the procedure?
Once you are brought into the procedure room, you will be asked to change into a hospital gown and lie on a table. Staff will connect you to a monitor to track your vital signs. You will be given IV sedation in the opposite arm to help you relax during the procedure. You will also be covered in sterile drapes.
Your provider will cleanse the area where your fistula is and inject medicine to numb the area. Once the area is numb, a small catheter is inserted into the dialysis access. Your provider will then inject contrast dye into access, which helps detect blood flow abnormalities and other changes with the help of real-time, X-ray imaging.
If your provider detects problems with your access point or surrounding vessels, they may simultaneously treat the problem using stents or blood thinners.
What is the recovery from an AV fistulogram like?
You will be transferred to a recovery room where nurses will monitor you for about one to two hours. We usually check vitals and signs of abnormal bleeding in your fistula. Once you are ready, you will be discharged and have someone drive you back home to resume your recovery.
At home, you should avoid strenuous activities for the rest of the day and eat and drink as usual. Avoid drinking alcohol, taking strong medicines, lifting heavy objects or driving for the first 24 hours. After that time, you can resume your usual activities if advised to do so by your doctor.
It’s completely normal to have some pain and swelling at the treatment site in the days after your procedure. These can be managed at home with over-the-counter pain medication and cold compresses. Make sure to keep the treatment site clean and look for any signs of infection, such as severe pain, swelling, redness, pus and fever.