Having a fistuloplasty
Fistuloplasty to unblock an arteriovenous fistula
A fistuloplasty is a non-surgical procedure to unblock an arteriovenous (AV) fistula. An AV fistula is when we connect an artery with a vein to access your bloodstream if you have haemodialysis.
Preparing for a fistuloplasty
Unless you are already staying in hospital, you can come into hospital, have a fistuloplasty and go home on the same day.
There are some things that can help you to prepare for the procedure.
Do
- Contact the interventional radiology (IR) department in advance if you need a hoist (piece of medical equipment to help lift or move you safely), transport or a translator.
- Arrange for an adult to take you home by car or taxi, and to stay with you overnight.
- Take your regular medicines (with sips of water if needed), unless your doctor has told you not to do this.
- If you have diabetes, ask your GP or diabetes nurse for advice on not eating (fasting) before the procedure. They can also explain any changes needed to your diabetes treatment. If you use insulin, your dose might need changing according to your blood sugar levels.
- If you take any medicines containing metformin, stop them on the day of the procedure and for 2 days afterwards. Metformin is a medicine used to treat type 2 diabetes and diabetes in pregnancy (gestational diabetes).
- Tell your doctor or nurse if you take any anticoagulants (like warfarin) or antiplatelets (like aspirin). These are medicines that help to prevent blood clots. You might need to stop taking them before the procedure.
- Bring all of your regular medicines with you. Examples are tablets, capsules, inhalers, sprays, liquids and patches. This includes anything that you buy yourself from a pharmacy or shop, and any herbal or homeopathic medicines.
Don't
- Do not eat or drink anything (except water) for 6 hours before the procedure. You can drink water (but not fizzy water) until 2 hours before the procedure. If you eat or drink before your procedure, we might have to cancel it.
Giving your permission (consent)
We want to involve you in decisions about your care and treatment. If you decide to have a fistuloplasty, we will ask you to sign a consent form. This says that you agree to have the treatment and understand what it involves.
If you would like more information about our consent process, please speak to a member of staff caring for you.
On the day of the procedure
On the day of your fistuloplasty procedure, you need to come to the renal day unit (Patience ward) at Guy's Hospital. Please arrive 15 minutes before your appointment to allow time to prepare.
We put a thin tube (cannula) into a vein in your arm and take a blood sample. You are then transferred to the interventional radiology (IR) department.
You can ask the IR doctor any questions that you have. We ask you to sign the consent form confirming that you agree to have the procedure. Please tell the X-ray staff when you arrive if you:
- are allergic to iodine (a chemical substance used in the contrast agent for X-rays) or anything else
- have previously reacted to the contrast agent used for X-rays and CT scans
- have asthma or diabetes
- are, or might be, pregnant
During the procedure
A fistuloplasty usually takes about 1 hour. You need to stay in hospital for about 3 to 4 hours after the procedure while we monitor you.
What happens during the procedure
- We ask you to lie flat on your back on an X-ray table.
- We attach monitoring equipment to you for measuring your blood pressure and heart rate.
- The IR doctor looks at your AV fistula using an ultrasound machine. This procedure is called a fistulogram. It allows the IR doctor to see the AV fistula more clearly.
- We put a small needle in your AV fistula and inject a substance called a contrast agent. This substance produces a picture of the blood vessels that would otherwise be invisible on an X-ray. The IR doctor looks at the pictures and finds the blockage or narrowing.
- We then pass a thin tube (catheter) through a blood vessel in your arm to the blockage inside the AV fistula. The catheter has a small balloon at the end. When the catheter reaches the area of the narrowing or blockage, we inflate and deflate the balloon several times. This stretches the blood vessel and should help to open the blockage.
- If the balloon does not improve the AV fistula or causes a complication, we might use a tube called a stent to open the blockage.
- After the procedure, we put a stitch at the place where we inserted the catheter (the puncture site). This is to help prevent bleeding. One of the dialysis nurses removes the stitch when you next come for dialysis. You do not usually need a dressing over the area.
How the procedure feels
Some people:
- get a warm feeling and a metallic taste in their mouth when we inject the contrast agent
- feel sick (nausea)
These feelings usually last for about 1 minute.
We inject a medicine called a local anaesthetic to make the area numb. This means that you do not feel pain during the procedure, but the medicine might sting before it starts to work.
We can give you painkillers if you need them.
Resource number: 3896/VER4
Last reviewed: August 2023
Next review due: August 2026
A list of sources is available on request.
