Radiology - Angioplasty

A guide to your renal fistula intervention

Why do I need a renal intervention?

Your tests have shown that there is a narrowed area in your fistula that is causing reduced blood flow and is affecting your dialysis. Your Consultant and a Radiologist (specialist X-ray doctor) have discussed your case and feel that the narrowing should initially be treated by angioplasty. In some instances, a diagnostic test called a fistulogram is required in the first instance. This will enable the doctors to plan the best treatment. If this is not treated or you decide not to have this procedure your fistula may block. The angioplasty is being performed as an alternative to an operation – if this is not successful an operation may still be required.

What does a fistulogram involve?

This is a non-surgical procedure done in the X-ray department, it is used to diagnose issues with your fistula This procedure takes between 15-30 minutes. A small needle is used (very similar to at dialysis), then a small tube is inserted into the fistula This allows x-ray dye to be injected so the doctors can assess the vessels in your arm. This will highlight any areas of narrowing. If suitable and prepped, this could be treated on the same day. Otherwise, you will be brought back another time for treatment after a plan is created.

What does a fistula angioplasty involve?

• It is a non-surgical procedure used to re-open blocked or narrowed blood vessels in your fistula arm. The procedure takes between 30 minutes and 1 hour
• Angioplasty is the inflation of a balloon inside the blood vessel at the area in which it is narrowed. This makes the opening of the blood vessel bigger and allows better blood flow
• The angioplasty is done in the X-ray Department
• You will be given local anaesthetic in the skin
• A small tube is passed into the fistula and positioned at the site of narrowing. The tube has a balloon at its tip which is then inflated and deflated. This may be repeated several times. X-rays are taken to check that the blood vessel has stretched open. Most patients do not feel the balloon inflating; however, some do feel pressure in the fistula for just a few seconds. Sometimes a second needle must be placed in another part of the fistula in order to perform the angioplasty
• When your angioplasty is completed, the tube is removed, and the radiologist will press on the incision site for a short time until it has stopped bleeding

What are the risks?

Complications of the angioplasty that may require an urgent operation are uncommon. Occasionally there may be a small bruise, called a haematoma, around the site where the needle has been inserted and this is quite normal. An operation may be required if the fistula bleeds following angioplasty. Surgery may also be needed if there is damage to the artery supplying the fistula or if the fistula blocks off during the angioplasty. Make sure you are satisfied that you have received enough information about the procedure before you sign the consent form.

Preparation

You will usually be admitted on the day of the angioplasty and you will be able to go home about an hour after the procedure if there are no complications.

Will it hurt?

When the local anaesthetic is injected, it will sting to start with, but this soon wears off, and the skin and deeper tissues should then feel numb.

After this, the procedure should not be painful. There will be a nurse, or another member of clinical staff, looking after you at all times.

Will I need to fast for my procedure?

No.

How will I be prepared?

• A member of staff will measure your blood pressure, pulse and temperature
• A fine tube (cannula) will be put into one of the veins in your arm. We will ask you to undress and put on a hospital gown

After the procedure

Following the procedure, you will be observed by ward staff to ensure your fistula continues to function and you will be discharged after an hour, if there are no complications. Please ensure that you have somebody to take you home and stay with you overnight.

Are there alternatives to renal fistula angioplasty?

Your consultant and radiologist have discussed your case and feel that the narrowing should initially be treated by angioplasty. An operation is usually possible as an alternative if you don’t want an angioplasty.

Could you be pregnant?

If there is any chance you could be pregnant, please call 0161 206 5091 if your appointment is at Salford Royal Hospital, or please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the booking office on 0161 204 2044/2404 (Salford Royal Hospital) or 0161 624 0420 (Royal Oldham Hospital) available Monday to Friday 8.30am to 4.00pm.

You can also email booking.radiology@nca.nhs.uk (Salford Royal Hospital) or bookingandscheduling.outpatients@nca.nhs.uk (Royal Oldham Hospital).

Please include name, date of birth, address and hospital number (if known) in any correspondence.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.

Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment and it may have to be rebooked.

If you need an interpreter

If you need an interpreter for your examination, please call the department so that we can try and arrange this.

Contact Details

We hope your questions have been answered by this leaflet.

If you require help or any other information regarding your appointment you can contact: -

The Angiography Department, Salford Royal Hospital - Tel: 0161 206 2206/5091

Interventional Radiology, Royal Oldham Hospital - Tel: 0161 656 1178