Failing or blocked dialysis fistula? Minimally invasive fistuloplasty, thrombolysis and permacath placement โ without surgery.
Dialysis removes waste and excess fluid from the blood for patients whose kidneys are no longer working. To do this repeatedly, patients need reliable dialysis access โ a connection to the bloodstream that can handle high blood flow, usually a radiocephalic fistula (above the wrist) or a brachiocephalic fistula (at the elbow).
| Complication | Symptoms | Intervention |
|---|---|---|
| Narrowing of the dialysis veins (outflow) | Arm, hand, face and one-sided chest swelling; decreased flow | Angioplasty of the veins (fistuloplasty) |
| Narrowing of the fistula site or arteries (inflow) | Decreased flow in the fistula | Angioplasty of the arteries |
| Acute thrombosis (clot) in the fistula | Sudden non-functioning of the fistula | Thrombolysis / thrombectomy |
| Immature or non-functional fistula | Needs maintenance haemodialysis but fistula unusable | Permacath placement |
A balloon reopens the narrowed vein or artery, sometimes with a stent to hold it open.
A clot is dissolved with medication delivered directly to it, under X-ray guidance.
A device breaks up and suctions out the clot directly.
A tunnelled catheter provides access while a permanent fistula matures.
A fistula that suddenly stops working is usually blocked by a clot. This is time-sensitive โ the sooner it is treated, the better the chance of saving it. Catheter-directed thrombolysis or mechanical thrombectomy can restore the fistula, avoiding the need to create a brand new access site altogether.
Swelling of the arm, hand, face, or one side of the chest usually means the dialysis veins have narrowed, so blood cannot drain away properly. It can be treated with a minimally invasive balloon procedure (fistuloplasty) to reopen the narrowed vein.
A fistula that suddenly stops working is usually blocked by a clot. This is time-sensitive โ the sooner it is treated, the better the chance of saving it via thrombolysis or thrombectomy, avoiding the need to create a new access.
Yes. Most failing or blocked fistulas can be rescued using minimally invasive, image-guided procedures โ balloon angioplasty for narrowing, or thrombolysis/thrombectomy for clots, with no surgical incision.
Fistuloplasty is a balloon angioplasty of a dialysis fistula. A catheter with a balloon is guided into the fistula, and the balloon widens the narrowed segment to restore blood flow. A stent may sometimes be placed to keep it open.
Warning signs include arm, hand or facial swelling, reduced flow during dialysis, difficulty achieving adequate dialysis, breathlessness from congestion, or the fistula suddenly stopping. Any of these should be assessed promptly.
A permacath is a tunnelled dialysis catheter that provides access for maintenance haemodialysis when a fistula is immature or not functioning, while a permanent access is prepared.
As soon as possible. Clot removal is time-sensitive, and prompt treatment substantially improves the chance of salvaging the fistula rather than needing a new access.
At Neuro & Vascular, dialysis access problems are treated by Dr. Suresh Giragani, Consultant Interventional Radiologist at Apollo Hospitals, Jubilee Hills, Hyderabad, with over 18 years of experience in vascular intervention.
Book a consultation with Dr. Giragani, or send your scans and reports for a specialist second opinion. Acting quickly saves fistulas.