Dialysis Management Alamogordo:
Dialysis Management Alamogordo provides help to patients with dialysis fistulas in Alamogordo, NM, and throughout the state of New Mexico. Doppler and color-flow ultrasound are two tools that can be used to help maintain the health of these unique blood vessels. The team at Dialysis Management Alamogordo can review your fistula with you, as well as explain how to monitor it yourself in the future. Contact us today to get started!
General Information:
Every day, many Americans with kidney failure undergo hemodialysis treatment. Kidney failure is progressive and incurable, but the life expectancy of patients can be lengthened with this procedure. The fistula is an abnormal passageway between an artery and vein in the arm, chest, or neck that’s created to allow for easy access to dialysis treatments. If stenosis develops or clot forms in the fistula, this can lead to serious complications and even death. At Dialysis Management Alamogordo we want our patients to remain as healthy as possible during their treatment and have developed diagnostic techniques that help us monitor the health of your fistula so you don’t have any surprises along the way.
The extent of Treatment:
Managing the fistulas is not easy. It is important to maintain the fistulation above a certain level so that hemodialysis can be given. If there is a narrowing of blood flow or clot formation, it must be addressed before it becomes serious. The fistulas can be monitored with Doppler and color-flow ultrasound to determine the status of the fistula. Treatment options are available, but they depend on whether or not you are on hemodialysis treatment as well as your age and medical condition.
Monitoring Type – Color-Flow Ultrasound versus Duplex Scanning:
There are two ways that fistulas can be monitored. The fistulas can be monitored with Doppler and color-flow ultrasound to determine if the flow is inadequate or if there is a narrowing (stenosis) or clot formation. If the flow is adequate and no stenosis or clotting has been detected, then the fistulas will not require any treatment. However, if the flow is inadequate, then it would be necessary for the physician to perform a procedure called angioplasty on the artery for it to go back into its normal shape.
Types of Abnormalities Found in Ultrasound Monitoring:
Dialysis fistulas can develop stenosis, or narrowing, due to an abnormal buildup of fibrous tissue. When this happens, the flow through the fistula decreases, and hemodialysis isn’t as effective. The stenosis can be treated with microsurgery that uses an endoscope (a slender, flexible telescope) inserted through one of the larger blood vessels in your arm into the fistula. If a clot has formed in the fistula, it may be dissolved using clot-busting medication. Ultrasound is also used to monitor for side effects from medications like high blood pressure and fluid retention.
Bacterial Infections:
The most common bacteria causing an infection in the hemodialysis fistula is Staphylococcus epidermidis. The bacteria may be introduced into the fistula during the creation of the fistula or due to contamination with skin organisms that enter through skin pores and hair follicles. The infection may also occur if there is a break in the protective cuff around the fistula that allows fluid to collect and grow bacteria. This type of infection is called perifistular (around the perimeter) or subfistulant (below the fistula).
Stenosing Procedures Performed on Fistulae in Our Office:
A surgical procedure known as angioplasty is often necessary for stenosed fistulae. We perform these procedures at our office, which allows for easy access and quick recovery time. This minimally invasive procedure can be performed in the physician’s office with minimal anesthesia and no incision. The fistulae are dilated using a balloon-tipped catheter that is inserted through the skin overlying the fistula. A balloon on the end of the catheter is inflated, which widens (dilates) the lumen of the vessel. If necessary, we can use stents to keep the opening open once it has been dilated. This procedure typically takes less than an hour and patients can go home that same day with few restrictions on activity or diet
External Surgical Treatments for Stenosing Problems:
Stenosis is when the diameter of the fistula narrows, limiting the flow through the fistula and potentially leading to clot formation. When these problems occur, the stenosis must be addressed quickly to avoid more serious complications such as clot formation or infection. Treatment for a stenosing problem may involve a simple nonsurgical procedure, such as using heat therapy or over-the-counter medications. If these treatments do not work, then surgery may be necessary. One type of surgical procedure that can be used is called fenestration. This procedure involves making small cuts into one side of the wall of the fistula and widening it by pulling apart the cut pieces.
