This content has been prepared in accordance with the regulations of the Republic of Turkey Ministry of Health and medical ethical rules, for the purpose of protecting public health and providing information. It does not contain any diagnosis, treatment guarantee, or guidance. Please consult an authorized healthcare facility for the most accurate information.
Dialysis fistula treatment encompasses interventional procedures to maintain patency of AV fistulas and grafts, which are the lifeline for hemodialysis patients.
What is a Dialysis Fistula?#
An arteriovenous (AV) fistula is a vascular access created for hemodialysis in patients with chronic kidney failure.
AV Access Types:
| Type | Description | Advantage |
|---|---|---|
| AV Fistula | Direct artery-vein anastomosis | Longest lifespan, less infection |
| AV Graft | Connection with synthetic tube | Quick use, easy cannulation |
| Central Catheter | Temporary access | Emergency use |
Most Common Fistula Locations:
- Radiocephalic (Brescia-Cimino): Wrist level
- Brachiocephalic: Elbow level
- Brachiobasilic: With transposition
Causes of Fistula Blockage#
Stenosis (Narrowing)#
Most common cause - 80%:
- Venous anastomotic stenosis: At fistula outflow
- Juxta-anastomotic stenosis: Near anastomosis
- Central vein stenosis: Subclavian/innominate vein
Thrombosis#
- Acute fistula occlusion
- Usually secondary to underlying stenosis
- Clot formation due to low flow
Other Causes#
- Hypotension (during dialysis)
- Excessive compression
- Hypercoagulability
- Infection
Signs of Fistula Problems#
Stenosis Signs#
- Low flow during dialysis
- Prolonged bleeding time
- Swelling in fistula arm
- Decreased thrill (vibration)
- High venous pressure
Thrombosis Signs#
- Loss of thrill and bruit
- Hard, painful fistula
- Acute arm swelling
- Inability to perform dialysis
Diagnostic Methods#
Physical Examination#
- Inspection: Swelling, redness
- Palpation: Thrill assessment
- Auscultation: Bruit character
Imaging#
Doppler Ultrasound:
- First-line evaluation
- Flow velocities and volumes
- Stenosis localization
Fistulography:
- Gold standard
- Anatomical detail
- Same-session treatment possible
Venography:
- Central vein evaluation
- Collateral vessels
Interventional Treatment Methods#
Percutaneous Transluminal Angioplasty (PTA)#
Primary treatment method:
- Stenosis dilation with balloon
- High-pressure balloons
- Repeated inflations
Success Rates:
| Location | Technical Success | 6-Month Patency |
|---|---|---|
| Venous stenosis | 95% | 50-60% |
| Arterial stenosis | 90% | 60-70% |
| Central vein | 90% | 30-40% |
Drug-Coated Balloon (DCB)#
Drug-coated balloon:
- Paclitaxel-coated
- Restenosis reduction
- Improved long-term patency
Stenting#
Indications:
- PTA-resistant stenosis
- Elastic recoil
- Central vein stenosis
- Rupture risk
Stent Types:
- Bare-metal stent
- Covered stent (stent-graft)
- Self-expanding stent
Thrombectomy#
For acute thrombosis:
Mechanical Methods:
- Aspiration thrombectomy
- Rotational thrombectomy
- AngioJet
Pharmacological Thrombolysis:
- tPA infusion
- Pulse-spray technique
Combined Approach#
Typical treatment protocol:
- Evaluation with fistulography
- If thrombosis present: Thrombectomy
- Stenosis identified: PTA
- If needed: Stenting
- Control imaging
Treatment Outcomes#
Success Rates#
| Procedure | Technical Success | 1-Year Primary Patency |
|---|---|---|
| PTA | 90-95% | 40-50% |
| DCB | 95% | 60-70% |
| Stent | 95% | 50-60% |
| Thrombectomy + PTA | 85-90% | 40% |
Follow-up Protocol#
- 1 month: Clinical evaluation
- 3 months: Doppler US
- 6 months: Doppler US or fistulography
- If problems develop: Urgent evaluation
Complications and Management#
Early Complications#
| Complication | Frequency | Management |
|---|---|---|
| Venous rupture | 2-5% | Prolonged balloon, covered stent |
| Distal embolization | 1-2% | Aspiration |
| Hematoma | 5% | Compression |
| Vasospasm | 5% | Nitroglycerin |
Late Complications#
- Restenosis: Most common, may require re-intervention
- Stent thrombosis: Thrombectomy + anticoagulation
- Infection: Antibiotic therapy
Fistula Preservation Strategies#
Patient Education#
- Fistula care
- Compression control
- Early symptom recognition
Dialysis Unit Collaboration#
- Regular flow monitoring
- Venous pressure monitoring
- Early referral
Surveillance Program#
- Doppler US every 3 months
- Dialysis parameter monitoring
- Proactive intervention planning
Special Situations#
Central Vein Stenosis#
- Subclavian/innominate vein
- Usually catheter history
- Stenting often required
Steal Syndrome#
- Cold hand, pain
- Banding or DRIL procedure
- Fistula ligation in severe cases
Aneurysm#
- True vs Pseudoaneurysm
- Treatment with covered stent
- Surgical repair
Frequently Asked Questions#
What is a dialysis fistula?
Why does a dialysis fistula become blocked?
Can a blocked fistula be opened?
Can dialysis continue after fistula treatment?
Is fistula blockage treatment risky?
Appointment and Contact#
To schedule an appointment for dialysis fistula evaluation and treatment:
📍 Eurasia Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Peripheral Interventions#
Other services related to dialysis fistula treatment:
- Peripheral Angiography - Vascular imaging
- Lower Extremity Arterial Disease - Leg vessel treatment
- Carotid Stenosis - Neck vessel treatment
- Renal Artery Stenosis - Kidney vessel treatment