Hemodialysis Access Maintenance/Declotting

Hemodialysis management provides kidney replacement therapy to patients with kidney failure either as a regular maintenance or on an emergency basis. An arteriovenous (AV) fistula, also called an artificial graft, can be surgically created by connecting an artery and a vein to make dialysis easier.

What Is a Fistulogram?
A fistulogram is used to evaluate renal access to a surgically created AV fistula that is not functioning properly. It can show if the blood flow is not high enough, pressures in the vein are too high or the graft is clotting frequently.

The procedure involves placing a tiny needle (smaller than a dialysis needle) into the fistula and injecting a contrast dye, which enables visualization within the fistula. If a blockage is detected, treatments such as venous angioplasty or stenting (renal dialysis access) may be performed.

Venous Angioplasty and Stenting
Venous angioplasty is a non-surgical procedure used to open or bypass narrowed veins and prevent clotting. A stent can also be placed to support a vessel or tissue in an open or expanded position to bypass scarred tissue and improve blood flow.

During a venous angioplasty, or venogram, an X-ray of the veins is used to identify blocked or narrowed vessels. Then a balloon-tipped catheter is inserted into the blocked vein and guided under fluoroscopic X-ray to the blockage. The balloon is inflated to correct the blockage and enable blood flow. In some circumstances, a stent mounted on the catheter is inserted and expanded to permanently adhere to the vessel walls to keep them open.

What to Expect
Prior to appointments, Gwinnett Medical Center patients are asked to come in for routine lab work. It is preferred that patients have their lab work performed at Gwinnett Medical Center so the radiology nurses have access to the results. Our radiology nurses call each patient shortly after the procedure is scheduled to obtain a health history and provide instructions.

For most interventional radiology exams, patients need to arrive in admissions two hours before their scheduled procedure time on the day of the exam. Patients will check in at admissions before being taken to the Imaging Nursing Unit, where an interventional radiologist will come to talk with the patient before the procedure. The patient will then be prepped for the exam and taken to the Interventional Radiology Suite for the procedure. Following the procedure, the patient will return to the Imaging Nursing Unit for recovery. The recovery time varies based on the procedure. After the patient is then discharged, he or she will receive a follow-up call the next day.

Call 678-312-3444 to schedule an appointment at one of our convenient locations in Lawrenceville, Duluth or Hamilton Mill.