Dialysis Graft / Fistula Management


Your kidneys are your body’s filter. If you have a condition that affects their ability to remove waste products from your blood, your physician may recommend dialysis. If you will be on dialysis for an extended period of time, it may be beneficial to have a dialysis graft or fistula implanted.

Grafts and fistulas are permanent access points for patients undergoing long-term dialysis.

A fistula is direct connection between your artery and your vein that promotes blood flow, making dialysis easier. A graft is similar to a fistula, but is created using a plastic connective tube.

Since grafts and fistulas are accessed several times a week for dialysis, scar tissue or blood clots can develop, blocking the site or causing a narrowing of the blood vessels and compromising blood flow.

If you’ve developed a blockage at your graft or fistula site, the Jefferson Surgical Interventional Center can help restore blood flow.

Our interventional radiologists use x-ray technology to evaluate dialysis grafts and fistulas for narrowing, blockages or other issues. If narrowing or blockages are present, we use x-ray technology to guide procedures that re-open the dialysis grafts and fistulas. The procedures we might use to clear a blockage of a graft or fistula, or widen the blood vessels are similar to those we used during angioplasty and vascular stent placement.

Treating narrowing of a dialysis graft or fistula

One of our interventional radiologists will insert a catheter tipped with a small balloon into the graft or fistula site, then inflate the balloon to widen the blood vessel and restore blood flow. The interventional radiologist may insert a stent, a thin mesh tube, to keep the vein open.

Treating a blockage in a dialysis graft or fistula

If a blockage is present in your dialysis graft or fistula site, your Jefferson Surgical interventional radiologist will use X-ray guidance to find the clot and treat it using clot busting medicine. If the medicine doesn’t dissolve the clot, we may perform a procedure called a thrombectomy. Thrombectomies involves the insertion of a small balloon to extract the clot and removes it from the blood vessel.

Frequently Asked Questions

Why do I need Dialysis Graft / Fistula Management?
There is an indication that your dialysis graft or fistula is clogged or narrowed and dialysis can’t be completed.
How do I prepare for Dialysis Graft / Fistula Management?

You should not eat or drink anything after midnight the night before your Dialysis Graft / Fistula Management.

Tell your doctor if you have had any kidney problems or reactions to x-ray dye or contrast. If so, your doctor may want to prescribe medicine for you to take before your procedure.

Ask your doctor about taking your regular medications prior to your Dialysis Graft / Fistula Management, especially Coumadin. Your doctor may want to stop your Coumadin for a few days prior to your procedure. Generally, your medications may be taken with a little sip of water. Please bring all medications you are currently taking with you on the day of your exam.

If you are a diabetic, consult your doctor about your diabetes medications.

Arrange for someone to drive you home and stay with you until the next day. You will not be able to drive, leave by yourself, or take a cab home without a companion.

Please notify your physician if there is any possibility that you are pregnant.

On the day of your Dialysis Graft / Fistula Management, wear comfortable clothes and shoes, and leave your jewelry and valuables at home if possible.

What happens before Dialysis Graft / Fistula Management?

You’ll check in with our receptionist and be asked to complete some paperwork. Please bring your insurance cards and a list of your medications.

A nurse and the interventional radiologist will talk to you about the procedure in detail. They will answer any questions you have and ask you to sign a consent form.

Then you’ll put on a hospital gown and the nurse will start an IV to give you fluids and medications. You may also need lab or blood work done before the procedure.

Our staff will show your family or companion(s) to our comfortable waiting room for the duration of your appointment.

What happens during Dialysis Graft / Fistula Management?

We’ll take you into our procedure room and perform an x-ray to determine if a blockage or narrowing of your dialysis graft or fistula is present. If so, we’ll shave, clean and drape the area, inject a local anesthetic, and make a very small incision.

If a blockage exists, such as a blood clot, we’ll deploy a catheter and inject a medicine to break up the clot and restore blood flow. This procedure is called catheter-directed thrombolysis.

If we’re not able to break up the clot with medication, we will perform a procedure called a thrombectomy, which is the removal of the clot. To treat narrowing, we’ll use angioplasty and vascular stent placement.

What happens after Dialysis Graft / Fistula Management?

After the procedure is complete, we’ll apply manual pressure to the area for 15-20 minutes or until the bleeding stops. We’ll apply a dressing to the site and take you to the recovery room. We’ll monitor your condition for 2-4 hours until you are ready to be discharged.

The staff will review discharge instructions with you and give you a copy of those instructions to take home.

Your family or companion will then drive you home and stay with you overnight.

The following day, you may resume your normal diet and medication schedule, unless otherwise directed. Ask your physician about exercising or working before you resume your normal routine.

We’ll send a report of your Dialysis Graft / Fistula Management to your primary care physician and his or her office will follow up with results and a forward care plan.