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Αγγειοπλαστική της αρτηριοφλεβικής επικοινωνίας

Information for patients from the Interventional Radiology Team and Renal Dialysis Access Team
This leaflet will inform you about having a Fistuloplasty/Venoplasty procedure. It will explain what is involved and what the possible risks are.
It is not meant to replace informed discussion between you and your doctor, but can act as starting point for such discussions. If you have any questions about the procedure please ask the doctor or renal access nurse who has referred you or the relevant department.

Who has made the decision?
Following your recent Fistulogram, a Fistuloplasty has been advised.
Your renal doctor, the renal access nurse and the interventional radiologist will have discussed your care and feel this is the most appropriate next step. However, you will also have the opportunity for your opinion to be considered and if, after discussion with your doctors, you no longer want the procedure you can decide against it. This procedure can be referred to as Fistuoplasty or a Venoplasty and relates to your fistula or graft vein.

What is a Fistuloplasty/Venoplasty?
Occasionally, the blood vessels that make up a fistula/graft can develop a narrowing which is diagnosed with a Fistulogram. A balloon called an angioplasty balloon is introduced into the area of narrowing inside the fistula /graft. This balloon is inflated from outside the body momentarily and then deflated to improve the narrowing. If this is in the fistula/graft it is called a Fistuloplasty. Very rarely, a special metal tube called a stent is inserted into the fistula/graft. This is permanent and keeps the narrowing open. Stents are generally only used if the balloon does not improve the narrowing satisfactorily or if there is a complication.

What are the risks of a Fistuloplasty/Venoplasty?
Fistuloplasty/Venoplasty, like a Fistulogram is very safe but occasionally complications do arise. There is small risk of failure of treatment. Sometimes the narrowing in a fistula/graft does not respond well to the Fistuloplasty/Venoplasty and requires a stent.

The risk of bleeding is slightly higher than a Fistulogram(about three in 100 chances)
There is a small risk that the treatment may damage or even rupture the fistula/vein. If this were to happen, the fistula/graft may fail and could not be used for dialysis. A small operation may be required at the time but more likely a line would me placed and a new fistula/graft fashioned. When considering the risk, it is important to bear in mind that leaving a narrowing in a fistula or vein, without treatment it is likely to lead to a fistula failure.

Are you required to make any special preparations?
You will be admitted as a day case to Marlowe Ward at Kent and Canterbury Hospital-please see appointment letter for date and time. If sedation or general anaesthetic is planned you will be provided with specific instructions in your appointment letter if you need to fast. We will ask your dialysis unit to take a clotting blood test the day before this procedure. If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.

Do I need to stop medication prior to the procedure?
Normal medication should be taken on the day of your procedure but specific instructions will be given in your letter or by your nurse if you take warfarin.

How long will it take?
The Fistuloplasty/Venoplasty can take about one hour but you can expect to be in the ward for at least four hours. Your procedure may be delayed if emergency cases take priority on the day. You will be kept informed if this happens.

Who will you see?
A specially trained team led by an interventional radiologist, they have specialized expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.

Where will the procedure take place?
In the endovascular theatre ,in the theatre department. This is similar to an operating theatre into which specialized x-ray equipment has been installed.

What happens during the procedure?
You will be asked to get undressed and put on a hospital gown. A small needle may be placed in your non-fistula arm in case you need an injection of a painkiller or light sedative. You will be asked to lie flat on your back. The skin over the area of your fistula/graft will be swabbed with an antiseptic and you will be covered with sterile drapes. Local anaesthetic will be injected into the skin. A needle, often followed by a fine plastic tube, will then be placed in the fistula/graft and dye injected. You will be asked to hold your breath for a few second while the images are taken. If you have a Fistuloplasty/Venolasty, you will have monitoring devices placed on your chest ad on your finger and if a sedative is given, you will be given oxygen via a face mask. Occasionally, it may be necessary to place a fine plastic tube in the vein in your groin as all the veins, as this may be a safer option than directly through the fistula.

Will it hurt?
Normally local anaesthetic is very effective at numbing the puncture site (which is little more than the dialysis needle in size) and the discomfort from the balloon is very brief. Sedation is sometimes recommended by the doctor or may be requested by you in advance of booking the procedure.

What happens after the procedure?
Light pressure is applied for a few minutes to the area where the needle/plastic tube was placed to prevent bleeding. You will need to stay in Marlowe Ward for at least one hour following a Fistuloplasty or Venoplasty. Your renal doctor and dialysis nurse will be informed of the procedure results. We recommend a transonic is measured at your next dialysis session.

Is it safe to have the procedures before/after haemodialysis?
Yes, the procedure will not interfere with the haemodialysis treatment.

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