Haemodialysis Fistuloplasty in Lucknow

A fistula is a surgical join between an artery and a vein, usually in the forearm or upper arm. It makes the vein thick and strong, so that two needles can be placed at each dialysis and blood can run quickly through the machine. When you rest your fingers on a healthy fistula, you feel a buzz called a thrill.

Repeated needling and the high flow itself can scar the vein wall and make it narrow. This often happens near the join or in the vein just past the needle sites. The narrowing is called a stenosis. A fistula that never develops properly can also have a narrowing from the start.

The usual signs are a weaker buzz, difficult needling and problems during dialysis. Many narrowings are first noticed by the dialysis nurses, but you can watch for changes too.

• The thrill is weaker or has gone, or the sound changes when your nurse listens to it.
• Bleeding takes longer to stop after the needles are taken out.
• Dialysis runs poorly: pressures on the machine are high, blood flow is slow, or your doctor tells you that dialysis is not clearing enough.
• The arm or hand swells, or prominent veins appear on the arm, shoulder or chest.
• The hand is cold, numb or painful, or part of the fistula is tender, red or ballooning.
• Needles are hard to place or keep slipping out.

Tell your dialysis nurse or nephrologist the same day. A narrowing found early can often be treated before the fistula clots, and a fistula that has already clotted is harder to rescue.

Fistuloplasty, also called fistula angioplasty, widens the narrowed segment from the inside. The skin is numbed and a small needle or sheath is placed in the fistula. Contrast dye is injected, and live pictures show the whole fistula and where it narrows. This test is called a fistulogram.

A fine wire is passed across the narrowing, and a balloon is inflated on it for a short time, once or more, until the narrowing opens. Tougher narrowings may need a stronger balloon, and sometimes a stent. Final pictures show the flow. The aim is to let you use the same fistula for dialysis again.

Fistuloplasty is considered when the dialysis unit or a scan shows a significant narrowing that affects flow, machine pressures or the quality of dialysis. It is often arranged between dialysis sessions, so that no session is missed.

A Colour Doppler scan can show the flow in a fistula and where it narrows, before any dye test. Ask your doctor whether it is needed, and the team confirms the scan when you book.

The alternatives are open surgical repair, a bypass graft, a new fistula at another site and, for a time, dialysis through a Permacath, which is a tunnelled catheter in the neck. The right choice depends on where the narrowing is, how often it returns and how long the fistula has been in use. Your nephrologist and a vascular access surgeon usually guide this decision.

Opening the narrowing can improve blood flow and make dialysis easier, but it does not make a fistula permanent. Narrowings often return, and repeat procedures are common over the years. Some narrowings do not open fully, and some fistulas have already clotted by the time they are seen.

The team explains the risks before you agree to the procedure.

• Bruising or bleeding at the needle site.
• Tearing of the vein during balloon inflation, which is usually managed during the procedure but may need a stent or surgery.
• Clotting of the fistula during or after the procedure.
• Allergy to the contrast dye, and infection at the needle site.
• Rarely, a clot or air travelling to the lungs, causing breathlessness or chest pain.

Suitability is decided from the fistula findings, your dialysis records and your kidney doctor's advice. Please send them to us before booking.

The team reviews your referral, dialysis chart, earlier fistula scans and recent reports first. After that review we confirm whether fistuloplasty is carried out at our centre or elsewhere, and by whom. If it goes ahead, the date is fixed with your dialysis unit so that your sessions can continue around it.

Never skip a dialysis session to fit in a procedure, unless your nephrologist has agreed to the plan. The wider range of interventional radiology procedures is on its own page.