Dialysis Fistula or 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.

About this Treatment

About this Treatment

How do we perform fistula or graft interventions?

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.

Then one of three things will happen:

  • 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.

Will my child be awake during the procedure?

No. We will administer sedating medications so that your child is asleep during the entire procedure.

Will my child be in any pain?

Your child will not feel pain during the procedure but some patients may feel discomfort around the tube insertion site for a few days following the procedure.

How long does the procedure take?

A typical fistula or graft intervention takes about one to two hours but may take longer. Some children may need to arrive many hours before the procedure to have certain lab tests performed, which will be clearly communicated to you.

What risks are associated with the procedure?

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)
Pre and Post Operative Care

Pre and Post Operative Care

We encourage good communication between you and your child, including the necessity and overview of the procedure as well as ensuring them that you are close by the whole time. Holding them or their hands until they leave for the procedure is a great way to provide support.

You will be given specific instructions along the way but you may need to arrive a few hours before the scheduled procedure to have some blood tests done. When you arrive at the hospital, a doctor will review the procedure and associated risks, after which you will sign a consent form. When we are ready to get started with the procedure, a nurse will place an intravenous line to deliver sedating medications and you will be allowed to accompany your child in the operating room until they are asleep, after which you will be escorted to a waiting room.

What happens 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.

When can my child bathe?

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.

Are there any activity restrictions?

Your child may return to normal activity as tolerated.

CONTACT US IMMEDIATELY IF YOUR CHILD EXPERIENCES ANY OF THE FOLLOWING:

  • Redness, pain, swelling, or bruising at the needle insertion site.
  • Fever higher than 101o Fahrenheit or 38o Celsius.
  • A change in color or temperature to the associated extremity.
  • Numbness, swelling, or pain of the associated extremity.

The department of Interventional Radiology can be reached at: (202) 476-3791, Monday through Friday, between 8 a.m. and 5 p.m.

At all other times please call (202) 259-8643, which is the on-call pager. Follow the instructions and wait for a call back.

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