PROCEDURE:
- Right/Left upper extremity AV fistulogram
- Central venoplasty
- Peripheral venoplasty
- Post venoplasty (Right/Left) upper extremity AV fistulogram
INDICATION:
DATE:
OPERATORS: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
MEDICATIONS: Versed mg IV, fentanyl mcg IV,
CONTRAST: mL of nonionic contrast
FLUOROSCOPY TIME: minutes
ACCESS: Right/Left upper extremity AV dialysis graft with ultrasound guidance
COMPLICATIONS: None
The risks, benefits, and alternatives to the procedure and sedation were explained. The specific risk of fistula occlusion and dialysis catheter placement was detailed and accepted. Written informed consent was obtained.
The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure.
The AV graft and overlying soft tissues were prepped and draped in sterile fashion. Ultrasonographic evaluation of the graft, arterial, and venous anastomoses was performed and an appropriate puncture site chosen. Under ultrasound guidance, the graft was punctured antegrade with a 21 gauge needle. Needle entry was documented and an image stored. A 0.018″ wire was passed centrally and the needle exchanged for a transitional dilator.
Diagnostic fistulography was performed from the access point to the right atrium using nonionic contrast.
A 0.035″ Bentson guidewire was manipulated centrally and advanced into the IVC. The transitional catheter was exchanged for a short 7F sheath. A 5 French Kumpe catheter was placed over the guidewire and the Bentson was exchanged for a 0.035″ Amplatz guidewire. The Kumpe catheter was removed. The stenosis at the left brachiocephalic vein was dilated sequentially with balloons. Post venoplasty venography was performed through the sheath.
The stenosis at the venous anastomosis was then treated sequentially with balloons. Post venoplasty venography was performed through the sheath.
Finally the AV graft was compressed and the arterial anastamosis was evaluated using nonionic contrast.
The sheath was removed and hemostasis achieved with purse string sutures/_____.
The patient tolerated the procedure well without immediate complications.
FINDINGS:
IMPRESSION:
Successful balloon dilatation of central and venous anastamosis stenoses as described.
Frequently Asked Questions
What is an AV fistulogram used for?
An AV fistulogram is a diagnostic imaging procedure used to evaluate the blood flow and detect any blockages or stenoses (narrowing) in an arteriovenous (AV) fistula, which is commonly used for dialysis. It helps in planning interventions like angioplasty to ensure the fistula functions properly for effective dialysis treatment.
Peripheral and central angioplasty involves using a catheter with a balloon to widen narrowed areas in blood vessels. During the procedure, a guidewire is inserted into the vessel, followed by a catheter. The balloon is inflated at the site of narrowing to restore proper blood flow. This procedure helps alleviate blockages in both peripheral (arms and legs) and central (near the heart) blood vessels.
What are the risks associated with an AV fistulogram and angioplasty?
The risks of an AV fistulogram and angioplasty include bleeding, infection, allergic reactions to contrast material, and potential damage to the blood vessels. There's also a risk of fistula occlusion, which may require additional procedures. However, these risks are generally low, and the benefits often outweigh them as it ensures the effective functioning of the dialysis access.
What medications are typically used during an AV fistulogram?
During an AV fistulogram, medications such as Versed (midazolam) and fentanyl are commonly used for conscious sedation. These medications help keep the patient relaxed and comfortable during the procedure while allowing them to remain awake and responsive. The specific doses are tailored to the patient's needs and monitored closely by medical staff.
How long does a fistulogram and angioplasty procedure take?
The duration of a fistulogram and angioplasty procedure can vary, but it generally takes about 1 to 2 hours. This includes preparation, the procedure itself, and post-procedure monitoring. The actual time under fluoroscopy, which is the imaging part, is usually only a few minutes. It's important for the patient to remain still during imaging to ensure accurate results.
Why is ultrasound guidance used during an AV fistulogram?
Ultrasound guidance is used during an AV fistulogram to accurately locate the AV fistula and ensure precise needle placement. It helps visualize the blood vessels and surrounding tissues in real-time, minimizing the risk of complications and improving the procedure's success rate. This technique enhances safety and efficacy in accessing the AV graft.
What is the recovery process after an AV fistulogram and angioplasty?
After an AV fistulogram and angioplasty, patients are typically monitored for a short period to ensure there are no immediate complications. Recovery is generally quick, with most patients able to resume normal activities within a day or two. It's important to follow any specific instructions from the healthcare provider regarding activity levels and care of the access site.
What is the purpose of using nonionic contrast in a fistulogram?
Nonionic contrast is used in a fistulogram to enhance the visibility of blood vessels during imaging. It is less likely to cause allergic reactions compared to ionic contrast agents and provides clear images of the fistula and surrounding vasculature. This helps healthcare providers accurately diagnose issues and plan appropriate interventions.