Dialysis Shunt Interventions

Why do I need a dialysis arterial venous shunt study?

Occasionally the shunt becomes narrowed or blocked, making dialysis more difficult or impossible. The narrowing may also occur anywhere in the veins between the arm and the heart. The study is performed in order to assess the connection and to intervene by means of angioplasty or stenting if necessary.

What will happen?

Hospital admission is not a prerogative for the procedure but this may depend on your general health condition. You will be brought to the Interventional Radiology Suite where the interventional radiologist (a doctor specially trained in these procedures) and radiographer will explain the procedure and answer your questions. The study usually takes about 60-90 minutes but may take longer if there are multiple narrowings. After completion, you will be monitored for 1 hour for possible complications.

Do I need any blood results?

You will be asked to have Pl/PTT/platelets in order to assess the risk of bleeding

We need to give you contrast (X-ray dye), so you should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking a procedure.

Procedure

No sedation is usually required. The shunt area will be cleaned with sterile soap and ultrasound machine will be used to locate the shunt. Under local anesthetic, a tiny incision will be made in your arm and a small soft tube (catheter) will be introduced into the shunt. Contrast injection will show if there is any significant narrowing or blockage. The radiologist will decide if it is necessary to perform angioplasty or stenting to correct the narrowing and the intervention will follow in the same setting. Upon completion, the tube will be removed and special stitches will be applied to prevent the bleeding. If the shunt is completely clotted, the radiologist may decide to mechanically evacuate thrombus or to perform thrombolysis. In the latter case you will need to stay in Intensive Care Unit for the close monitoring.

Does it hurt?

You will feel a bee sting when the doctor numbs the entry site. Most patients feel mild discomfort during the inflation of angioplasty balloon.

What are the risks?

The risk of infection is very low but we may need to give you antibiotics if the procedure lasts longer than anticipated.

The risk of bleeding during the procedure is minimal and is simply treated by elevation of your arm. The other complications are similar as for general angiography.

When will I get my results?

The radiologist will be able to talk to you immediately after the procedure.

When will I resume my normal activities?

In most cases, you will be able to get back to your normal activity the next day. You should avoid any extensive physical activities and particularly it is advisable not to lift any heavy object.

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