Fistula occlusions are a serious problem for dialysis patients. These occlusions can develop over time and directly affect the success of dialysis treatments. Keeping fistulas patent is essential for patients’ quality of life. Therefore, interventional radiology plays a major role in treating fistula occlusions using angiography.
Angiography can effectively open narrowed or thrombosed vessels. This allows patients to connect to dialysis machines regularly and helps prevent more serious health issues in the long term.
| Kategori | Information |
| Treatment Method | Dialysis Fistula Occlusion Clearance |
| Indication | Used to restore blood flow when a dialysis fistula becomes occluded |
| Indications | Fistula occlusion, insufficient fistula function, fistula thrombosis |
| Procedure Description | Angioplasty (balloon dilation) or stent placement is used to clear fistula occlusions |
| Advantages | Minimally invasive, does not require general anesthesia, quickly restores fistula function |
| Complications | Bleeding, infection, vessel injury, re‑occlusion of the fistula |
| Success Rate | High success rate; angioplasty and stenting are generally effective |
| Recovery | Rest for a few days post‑procedure; regular fistula checks are required |
| Alternative Treatments | Surgical revision, creation of a new fistula, use of a hemodialysis catheter |
| Preparation & Precautions | Hold anticoagulants before the procedure, use local anesthesia during the procedure, post‑procedure care and follow‑up |
| Epidemiology | A significant proportion of dialysis patients develop fistula occlusions over time; clearance is often necessary |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
The Importance and Function of the Dialysis Fistula
This surgically created connection between an artery and a vein plays a critical role in dialysis. It enables rapid, efficient blood flow to the dialysis machine, allowing blood to be cleaned and returned to the patient’s body. Healthy fistula function is essential because it:
- Maximizes blood flow.
- Enhances the efficiency of dialysis.
- Meets the patient’s treatment needs.
- Allows more blood to be filtered during each session.
Maintaining a patent, functional fistula requires regular monitoring and care. A well‑functioning fistula is vital for an effective dialysis experience.
Factors Leading to Fistula Clearance
The dialysis fistula is lifeline for patients with renal failure, enabling blood purification during dialysis. However, fistula formation and function depend on multiple factors.
- Diabetes
- Hypertension
- Heart disease
These conditions impair kidney function over time, leading to renal failure.
Vascular Health:
- Age‑related vessel damage
- Hypertension‑induced vessel damage
- Diabetes‑related vessel damage
Damaged vessels complicate fistula creation.
Surgical History:
- Previous surgeries
- Operative interventions that alter vessel anatomy
Vascular Changes:
- Stenoses
- Vessel dilation due to low blood pressure
These factors affect blood flow and fistula formation. Awareness of these risks helps manage treatment.
Signs of Fistula Complications
Dialysis fistula patients may experience various complication signs. Swelling at the fistula site often indicates inadequate blood flow or infection. Pain or tenderness in the area also suggests functional issues.
- Swelling: from poor flow or infection.
- Pain: due to low flow or infection.
- Redness: may indicate infection or low flow.
- Stenosis: from low flow or surgical changes.
- Occlusion: from thrombosis or poor flow.
Patients should seek medical attention immediately if these signs appear. Early intervention prolongs fistula life and improves quality of life.
Diagnosis of Fistula Problems
Various tests and imaging techniques diagnose fistula issues. First, a physical exam assesses swelling, redness, and tenderness. Then, further tests include:
- Doppler ultrasound: measures blood flow in the fistula.
- Fistulography: Contrast agent injection with X‑ray imaging of the fistula.
- MR angiography: MRI with contrast to evaluate vessel status.
- Flow measurement: assesses adequacy of blood flow.
These tests determine flow adequacy and identify any stenosis or occlusion. Results guide appropriate treatment selection.
Angiographic Clearance of Fistula Occlusions
Fistula occlusions in dialysis patients are effectively treated with angiography. This minimally invasive method reduces risk and promotes rapid recovery. During the procedure, a catheter is advanced to the occlusion site. Techniques include:
- Balloon angioplasty: inflating a balloon to dilate the vessel.
- Stent placement: deploying a metal stent to prevent re‑occlusion.
- Thrombectomy: removing or dissolving clots with specialized tools or medication.
These interventions preserve fistula function, enabling continued dialysis and improving patient outcomes.
Advantages of the Angiographic Method
Angiography offers significant benefits for fistula occlusion treatment. Its minimally invasive nature eliminates the need for major surgery. A small incision suffices, accelerating recovery. Most patients are discharged the same day, reducing hospital stays. Key advantages include:
- Minimal Invasiveness: small incisions, no major surgery.
- Rapid Recovery: same‑day discharge possible.
- High Efficacy: excellent success in clearing occlusions.
- Low Risk: generally safe with few complications.
- Patient Comfort: performed under local anesthesia.
These factors make angiography the preferred approach for treating dialysis fistula occlusions, maximizing both safety and efficacy.
Risks of Angiographic Fistula Clearance
While effective, angiographic fistula clearance carries certain risks. Common complications include bleeding at the access site, which usually resolves spontaneously but may rarely require intervention. Other potential risks are:
- Bleeding: typically self‑limiting.
- Stroke: from embolized clots.
- Heart attack: increased cardiac oxygen demand during the procedure.
- Contrast reactions: possible allergic responses.
- Vessel injury: arterial damage may cause further occlusions.
- Infection: risk at the puncture site.
These risks are rare, and most patients recover fully. Individual risk depends on overall health and comorbidities. Thorough pre‑procedure evaluation is recommended.
Post‑Procedure Care
After angiography, patients should rest for several hours to support cardiovascular stability. Adhering to medical instructions enhances recovery. Key post‑procedure steps include:
- Adequate rest for several hours.
- Take medications as prescribed.
- Maintain a healthy diet.
- Avoid smoking and alcohol.
- Perform doctor‑recommended exercises.
- Attend follow‑up appointments promptly.
These measures help protect cardiovascular health and minimize complications. Seek medical attention if any abnormalities occur.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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