What is a fistula/graft declotting and intervention procedure in dialysis patients?

Patients with kidney dialysis use a special machine to remove waste products from their bodies through artificial blood vessel connections called grafts or fistulas. Such artificial pathways remove blood from the body, cleanse it of waste and extra fluid and then return it back to the body. Sometimes the graft or fistula can get clogged or becomes narrow and therefore require angioplasty or vascular stenting by an Interventional Cardiologist to open it
up. A graft or fistula can also be opened up by a technique called catheter-directed thrombolysis.

What happens in a dialysis procedure?

For a person to undergo dialysis procedure a Nephrologist/ Renal Specialist will first create an access to the patient’s blood vessel using one of the three methods:
1. By Fistula: A fistula is made by joining an artery with a vein to make a larger high flow blood vessel.
2. By a Graft: In this case, a high flowing artificial pathway is created by placing a tube between an artery and vein.
3. Catheter access: According to this method, a narrow plastic tube is inserted into a large vein in the groin or neck area.

Hence, when fistulas and grafts become clogged or are narrowed, thus preventing patients to undergo dialysis, specialists like Interventional Cardiologists can use image-guided interventions to help solve such a problem.

How can fistula/graft declotting and intervention help a patient with dialysis?

Dialysis fistula/graft declotting and interventions are minimally invasive procedures performed to improve or restore blood flow in the fistulas or grafts placed in the blood vessels of dialysis patients. Such procedures are often done on an outpatient basis using X-ray imaging equipment, a balloon catheter, guide wire, catheter, sheath, stent or a medical device that breaks up or dissolves blood clots.

What happens in a fistula/graft de clotting and intervention procedure?

Using Cath lab imaging guidance at Paris Cardiology Center Cath Lab, Dr. Khalid Shafiq will use an inflatable balloon mounted at the tip of a catheter,
which will be inserted through the skin into the fistula or graft and advanced to the blockage. Once deployed, the balloon will be inflated and deflated. During this process the balloon will expand the vein or artery wall, increasing blood flow through the fistula or graft. A stent may be placed to hold the vessel open.

 When there is reduced flow in a graft or fistula, angioplasty with vascular stenting may be performed.
 However when there is thrombosis of dialysis fistulas or grafts involved (i.e. when the blood in the vessels turn from a free-flowing liquid to semi-
solid gel called blood clot or thrombus) then a catheter-directed thrombectomy (clot removal by physically removing or smashing it) or thrombolysis (with clot-dissolving drugs) may be performed.

What are the benefits of such a procedure to a dialysis patient?

 These procedures are performed as an outpatient at Paris Cardiology Center Cath Lab with no overnight stay. Patients are discharged after a few hours the same day. A patient can resume his/ her normal activities soon after the procedure.
 No surgical incision is given, only a small nick on the skin that does not have to be stitched.
 No general anesthetic is required in the majority of patients.



Click here to read more from Ayesha
Health Contributor, eParisExtra.com

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