Haemodialysis access interventions

Haemodialysis fistula/ grafts frequently malfunction due to gradual narrowing or even blockage of the fistula.

During the procedure, local anaesthesia (pain killer) is injected into the skin at the pinhole access into the fistula/ graft to prevent discomfort. An injection of a mild sedative can also be given to ensure that you are comfortable and relaxed during the procedure.

Initially an angiogram is performed to identify the severity and the location of the blockage. And, then angioplasty or stenting is performed as required to treat the blockage.

Drug coated balloons have been proven to reduce/ delay the risk of recurrence of the narrowing. Hence these are recommended in cases where the narrowing recurs within a short period of treatment with standard balloon angioplasty.

Some patients develop complete clotting of the entire fistula/ graft, if the vessel narrowing (culprit lesion- reason for the clotting) is not identified / treated at the right time. In such patients, catheter directed thrombolysis or thrombectomy its first performed to remove the clot from the entire fistula and then the ‘culprit lesion’ is treated with angioplasty or stenting.