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Dialysis Fistula and Graft Declotting

Last updated Jan. 26, 2019

Anna Frodesiak

Image showing an individuals arm while receiving dialysis (the reason a declot would be necessary).


Background Information:

What are the other Names for the Procedure?

  • Dialysis and Fistula/Graft Declotting and Interventions
  • Dialysis Fistula/Graft Declotting Interventions 

What is Dialysis Fistula and Graft Declotting radiology procedure? (General Explanation)

  • Dialysis Fistula and Graft Declotting procedures are minimally-invasive procedures performed to improve blood flow in the fistula and grafts, placed in the blood vessels of dialysis patients
  • The procedure is usually performed in patients for the following reasons:
    • Kidney problems, where kidneys are unable to filter blood
    • To remove wastes from blood
  • In order to perform a dialysis, it requires an access to the blood vessels. This is created by using a fistula, graft, or a catheter:
    • A fistula is created by connecting an artery and vein
    • A catheter is inserted into a large vein in the groin or neck region
  • The narrowing or clogging of grafts or fistula can create problems during dialysis. Hence, in order to remove such narrowing or clogging, declotting interventions like catheter-directed thrombolysis, angioplasty and vascular stenting procedures are used
  • Angioplasty and vascular stenting uses a balloon to open up the fistula or graft, and the stent is placed to keep the fistula/ graft open
  • Catheter-directed thrombolysis breaks down the clot built-up in the fistula or graft

What part of the Body does the Procedure involve?

A Dialysis Fistula/Graft Declotting Intervention procedure is commonly performed in the veins of the groin or neck.

Why is the Dialysis Fistula and Graft Declotting radiology procedure Performed?

When a blockage occurs in the fistula or graft, it can prevent a patient from undergoing a dialysis. Dialysis Fistula and Graft Declotting procedures are designed to help improve blood flow in the fistula and grafts, placed in the blood vessels.

What is the Equipment used? (Description of Equipment)

The equipment used for Dialysis Fistula and Graft Declotting procedures could include:

  • An X-ray machine
  • A monitor
  • An examination table
  • A catheter - a thin, long, hollow tube which is used to apply medications, to break down the clots in the graft or fistula
  • Stents - metal tubes that keep the graft/fistula open
  • A graft - a soft plastic tube, which is placed between the artery and vein, to create high-flow blood vessel

What are the Recent Advances in the Procedure?

There have been no recent advances with respect to Dialysis Fistula and Graft Declotting procedures. 

What is the Cost of performing the Dialysis Fistula and Graft Declotting radiology procedure?

The cost of a Dialysis Fistula/Graft Declotting Intervention procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Dialysis Fistula and Graft Declotting procedure and what needs to be done.
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician.
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=dialysisfistulagraft (accessed on August 3, 2014)

Prior to Dialysis Fistula and Graft Declotting radiology procedure:

How does the Dialysis Fistula and Graft Declotting radiology procedure work?

  • Catheter thrombolysis: A catheter is inserted into a blood vessel and advanced to the blockage using X-ray guidance and contrast material. Medications are injected into the catheter, in order to break down the clots
  • Angioplasty and vascular stenting: A catheter with a balloon is inserted into a blood vessel and advanced to the blockage using imaging guidance. Once at the blockage, the balloon is inflated to open the graft/fistula; this inflation opens up the blood vessel and increases blood flow. A vascular stent, which is a like a metal tube, may be inserted in the vessel, to keep it open after the balloon is removed 

How is the Dialysis Fistula and Graft Declotting radiology procedure Performed?

The Dialysis Fistula and Graft Declotting procedure is performed as follows:

  • The patient is positioned on the table, where an intravenous (IV) line is inserted into the vein, to inject sedative medications
  • The area of catheter insertion is cleaned and a local anesthetic applied
  • For a catheter thrombolysis procedure:
    • A catheter is inserted into the blood vessel and advanced to the blockage, using x-ray guidance and contrast material
    • Medications, called thrombolytics are injected into the catheter to break down the build-up of clots
    • The catheter is removed at the end of the procedure
  • For angioplasty and vascular stenting procedure:
    • A sheath is inserted into the graft/fistula
    • A catheter with a balloon is inserted into the blood vessel through the sheath and advanced to the blockage using imaging guidance
    • Once at the blockage, the balloon is inflated to open the graft/fistula; opening the graft/fistula, increases the blood flow required
    •  A vascular stent may be inserted in the vessel to keep it open, after the balloon is removed

Where is the Procedure Performed?

Dialysis Fistula/Graft Declotting Interventions are performed as outpatient procedures, at a hospital.

Who Performs the Procedure?

An interventional radiologists perform the Dialysis Fistula/Graft Declotting Intervention procedure.

How long will the Procedure take?

A catheter thrombolysis usually takes about less than an hour.

Who interprets the Result?

An interventional radiologist interprets the results of the Dialysis Fistula and Graft Declotting procedures. This is then informed to the patient by the healthcare provider. 

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Dialysis Fistula and Graft Declotting procedure procedure:

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
  • It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
  • Women should notify the physician, if they are pregnant or breastfeeding their child; as many such procedures may not be performed on pregnant women
  • Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations, before the preparation sessions
  • The patient may be asked to avoid eating or drinking, several hours before the test
  • Specific instructions may be given on how to prepare for the Dialysis Fistula/Graft Declotting Intervention procedure a few days before the actual procedure

What is the Consent Process before the Procedure?

A physician will request your consent for the Dialysis Fistula and Graft Declotting procedures using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Dialysis Fistula/Graft Declotting Intervention procedure:

  • The procedure is minimally-invasive; no surgical incision is necessary
  • For catheter thrombolysis, it is:
    • Safe and highly effective
    • There is only a short hospital stay involved
    • Less invasive than a surgery
  • For angioplasty and vascular stenting:
    • The recovery is quick
    • Most of the time, only a local anesthesia is required

Following are the risks of the Dialysis Fistula/Graft Declotting Intervention procedure:

  • There is a risk of infection due to catheter insertion
  • Very rarely, complications, such as sudden cardiac death or heart attack, may occur
  • Damage to the fistula or graft
  • Renal failure, due to contrast material, in rare cases
  • Bleeding at the catheter insertion site
  • Damage to the vein or artery, due to catheter insertion
  • Recurrence of blockage following an angioplasty may occur
  • Rare complications, such as sudden vessel closure after balloon angioplasty may occur, which may require angioplasty or bypass surgery

What are the Limitations of the Dialysis Fistula and Graft Declotting radiology procedure?

Limitations of the Dialysis Fistula/Graft Declotting Intervention procedure include:

  • Some difficult blockages may require surgeries and cannot be corrected, using catheter thrombolysis or angioplasty 

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What are Dialysis Fistula and Graft Declotting procedures?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Dialysis Fistula and Graft Declotting radiology procedure:

What is to be expected during the Dialysis Fistula and Graft Declotting radiology procedure?

The following may be expected during the Dialysis Fistula and Graft Declotting procedure:

  • The patient may feel a slight pain, when the intravenous line is inserted
  • The patient may feel pressure during catheter insertion and a warm sensation, if a contrast material is used
  • The patient’s heart rate and blood pressure will be continuously monitored

What kind of Anesthesia is given, during the Procedure?

The patient is administered general anesthesia for the Dialysis Fistula and Graft Declotting procedure.

How much Blood will you lose, during the Procedure?

Dialysis Fistula and Graft Declotting procedures are minimally invasive; they involve little to no blood loss.

What are the possible Risks and Complications during the Dialysis Fistula and Graft Declotting radiology procedure?

The possible risks of a Dialysis Fistula/Graft Declotting Intervention procedure include:

  • There is a risk of infection that may occur from catheter insertion
  • In rare cases, heart complications, such as a sudden cardiac death or a heart attack may occur
  • Damage to the fistula or graft
  • Renal failure, due to contrast material may occur, in some rare cases
  • Bleeding at the catheter insertion site
  • Damage to the vein or artery, due to catheter insertion
  • Recurrence of blockage following an angioplasty
  • Rarely, complications, such as a sudden vessel closure after balloon angioplasty may occur. This may require an angioplasty or a bypass surgery

What Post-Operative Care is needed at the Healthcare Facility after the Dialysis Fistula and Graft Declotting radiology procedure?

There is no postoperative care necessary after a Dialysis Fistula and Graft Declotting procedure, at the healthcare facility.

After the Dialysis Fistula and Graft Declotting radiology procedure:

What is to be expected after the Dialysis Fistula and Graft Declotting radiology procedure?

The following may be expected after Dialysis Fistula and Graft Declotting procedures:

  • For catheter thrombolysis:
    • Pain medications may be given, if the patient experiences pain after the procedure
  • For angioplasty and vascular stenting:
    • The patient is advised rest and must avoid heavy lifting and exercise for a minimum period of 24 hours
    • Bleeding at catheter site may occur in some cases. During such bleeding episodes, the patient should apply pressure at the site and lie down. They should aslo contact their healthcare provider
    • The patient may need to take some medications, such as Coumadin, to prevent clotting

If there is no improvement in one’s condition after the procedure, then do contact your physician.

When do you need to call your Physician?

  • If there is significant pain after the procedure, or if bleeding from the catheter site occurs after the Dialysis Fistula/Graft Declotting procedure
  • If the patient experiences fever or chills
  • In case there is any pain or change in color of their legs or arms, the patients should immediately contact the physician 

What Post-Operative Care is needed at Home after the Dialysis Fistula and Graft Declotting radiology procedure?

Post-operative care necessary at home after the Dialysis Fistula and Graft Declotting procedure include:

  • Proper rest for 24 hours
  • No heavy-lifting or strenuous exercises for the next 24 hours (minimum period)
  • Take medications, as prescribed

How long does it normally take to fully recover, from the Procedure?

  • The recovery from an angioplasty and vascular stenting procedure, usually takes about 24 hours
  • The catheter thrombolysis procedure may require a short period of hospitalization

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

No tissue is extracted from the patient during a Dialysis Fistula and Graft Declotting procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Dialysis Fistula and Graft Declotting radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • A radiologist or vascular surgeon, performing the procedure
  • Healthcare providers, physicians, who is involved in the process

The patient is advised to inquire and confirm the type of billing, before the Dialysis Fistula and Graft Declotting procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 30, 2014
Last updated: Jan. 26, 2019