PROCEDURE:Â
- AV fistulogram
- Venous angioplasty
CLINICAL HISTORY: Patient is a _____ with history of end-stage renal disease and prior AV fistula placement. Patient with abnormal pressures during dialysis.
DATE OF PROCEDURE:Â Â Â Â
OPERATORS:Â John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â Â
MEDICATIONS: Versed   mg IV, Fentanyl   ug IV, Heparin   units IV
CONTRAST:   cc Visipaque 320
COMPLICATION: None.
PROCEDURE:
The risks and benefits and alternatives of the procedure as well as conscious sedation were discussed with the ______ . After obtaining informed consent the patient was prepped and draped in the usual sterile fashion.
The skin and subtends tissue overlying the AV fistula was infiltrate with 1% lidocaine without epinephrine. The AV fistula was accessed towards the venous side utilizing a micropuncture technique. Multiple injections were made through the transitional dilator with imaging of the   upper extremity and centrally. The venous end was then manually compressed and repeat contrast injection through the transitional dilator was performed to visualize the remainder of the AV fistula and the arterial anastomosis. The dilator was then removed over a 0.035 Bentson wire and a 6 French short sheath was placed. A 6 mm by 4 cm Conquest balloon was then passed over the wire and used to dilate the multiple areas of stenosis throughout the venous outflow tract. Next, a 8 mm x 4 cm Conquest balloon was then passed over the wire and used to redilate the area of stenosis. The images were reviewed. The sheath was then removed and hemostasis achieved utilizing manual compression. Sterile dressing was applied.
The patient tolerated the procedure well and left the angiography suite in stable condition without any immediate postprocedural multiple areas of stenosis complications.
FINDINGS: Multiple areas of stenosis throughout the venous outflow tract, which is the cephalic vein. No evidence of central stenosis. No evidence of stenosis and at the arterial anastomosis.
INTERVENTION: Venoplasty of the venous outflow track with a 6 mm by 4 cm balloon and a 8 mm x 4 cm balloon. Post venoplasty, no evidence of residual stenosis.
IMPRESSION:
- Multiple areas of stenosis throughout the venous outflow tract, which was successfully dilated. No residual stenosis was identified after balloon angioplasty.
Frequently Asked Questions
What is an AV fistulogram with angioplasty?
An AV fistulogram with angioplasty is a medical procedure used to evaluate and treat blockages in an arteriovenous (AV) fistula, which is often created for patients undergoing dialysis. The fistulogram involves imaging the blood vessels to identify areas of narrowing or blockage, known as stenosis. Angioplasty is then performed to widen these narrowed areas using a balloon, restoring proper blood flow.
Why would a patient need an AV fistulogram?
A patient may need an AV fistulogram if they have an arteriovenous fistula for dialysis and are experiencing issues like abnormal blood flow or pressure changes during dialysis sessions. These symptoms may indicate stenosis, or narrowing, in the blood vessels, which needs evaluation to ensure effective dialysis treatment.
What are the risks of an AV fistulogram with angioplasty?
The risks associated with an AV fistulogram with angioplasty include bleeding, infection at the puncture site, allergic reactions to contrast dye, and damage to the blood vessels. However, these risks are generally low, and the procedure is considered safe. Complications are rare, but it's important for patients to discuss potential risks with their healthcare provider.
The procedure begins with the patient receiving a local anesthetic. A small needle is used to access the AV fistula, and contrast dye is injected to visualize the blood vessels. If stenosis is detected, a balloon catheter is inserted and inflated to widen the narrowed sections. The procedure is minimally invasive and typically well-tolerated by patients.
What are the signs of successful angioplasty in an AV fistula?
Successful angioplasty in an AV fistula is indicated by restored blood flow and the resolution of any stenosis. Post-procedure imaging should show no residual narrowing in the treated areas. Clinically, patients may notice improved dialysis performance, with fewer issues like clotting or high pressures during treatment.
What does venous outflow tract stenosis mean?
Venous outflow tract stenosis refers to the narrowing of the veins that carry blood away from the arteriovenous fistula. This condition can impede adequate blood flow and affect the efficiency of dialysis. Angioplasty is often used to treat this type of stenosis by widening the narrowed sections of the vein.
What medications are used during an AV fistulogram with angioplasty?
During an AV fistulogram with angioplasty, medications such as Versed (a sedative), Fentanyl (a pain reliever), and Heparin (a blood thinner) may be administered. These medications help manage pain, anxiety, and prevent blood clots during the procedure, ensuring patient comfort and procedural efficacy.
How long does it take to recover from an AV fistulogram with angioplasty?
Recovery from an AV fistulogram with angioplasty is typically quick since it is a minimally invasive procedure. Most patients can resume normal activities within a day or two, although they should follow specific post-procedure instructions from their healthcare provider to ensure proper healing and monitor for any complications.