What is a fistulogram?

The problems arising in an AV Fistula or its access site can be detected by a test called fistulogram, where abnormal areas of the AV Fistula will be found. The areas which are observed by a fistulogram are: 

  • Blocked veins and arteries also called as occlusions
  • Abnormal narrowing also called as stenosis
  • Places of abnormal enlargement also called as pseudo aneurysm

Fistulogram is considered as the safest and one of the most commonly used procedure that requires around 30-60 minutes for the completion of the test.

Why a fistulogram is required?

  • If there is restricted or less blood flow in the AV fistula access site
  • If there are any problems related to dialysis which might be the result of access site
  • Encountering any of the symptoms which might result from access site
  • If there is prolonged bleeding from the access site after dialysis.

How is a fistulogram performed?

  • Patients are not supposed to eat solid foods for 3 hours before the performance of the minimally invasive test. However, fluids without milk are allowed.
  • A local anesthesia is generally not required.
  • Dialysis access needle is inserted in the graft.
  • The radiographic pictures are taken from the desired area with the injection of x- ray contrast material or x-ray dye which might make the patient to feel warm for some time.
  • Any problems with the narrowing can be treated by opening and stretching the narrowed area by the procedure called as angioplasty or fistuloplasty.
  • In fistuloplasty, a tube which has a deflated balloon at its tip is placed. The balloon is usually deflated and inflated several times by positioning the balloon at the blockage site. There may be a feeling of discomfort when there is inflation of the balloon. 
  • The graft requires opening if the inflation of the small balloon is not successful.
  • In order to keep the narrowed area open throughout the procedure, a metal mesh tube called stent is placed. The stent will act by widening the vessels and improves the blood flow.
  • If there is any block in the blood vessels due to blood clot which is shown on fistulogram, it is generally removed by giving some special drugs in order to remove or dissolve the blood clot. Removal of the blood clot can be alternatively done with the use of a mechanical device.
  • Needle/Catheter which was inserted is removed and pressure is applied at the puncture site at the end of the procedure.
  • Though fistulogram is an outpatient procedure, there would be requirement of someone to drive the patient home. 

What to expect after a fistulogram test?

There might be minimal pain or infection which results because of the insertion of IV needle. The pain will go away with the administration of pain control agents.  Allergic reactions such as hives, rash, itching, nausea might result which can be avoided by taking anti-allergic medications.

What are the precautions which need to be taken after a fistulogram procedure?

  • Avoid participating in stressful physical activity or using heavy machines 
  • Do not drink alcohol while under medications which cause drowsiness. .
  • Avoid lifting heavy weights.
  • Don’t wear anything which might be tight on the wound. 
  • Don’t do anything energetic with the arm, for at least one day after the performance of the test.

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Dr. Ajay Shetty.

Senior Consultant - Urology & Andrology

Dr. Sushma Rani Raju.

Consultant - Nephrology

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