For patients on dialysis, having a reliable access point is the lifeline that makes treatment possible. Unfortunately, problems such as narrowing or clotting of fistulas and grafts can interrupt this process, leading to ineffective dialysis and repeated procedures. Angioplasty offers a minimally invasive way to restore blood flow and keep dialysis access functioning properly. By widening narrowed blood vessels, this procedure helps patients maintain consistent treatments, reduce complications, and improve overall quality of life.
In This Blog:
- Understanding Dialysis Access
- What Is Angioplasty?
- Why Angioplasty Is Needed for Dialysis Patients
- The Procedure: Step by Step
- Benefits of Angioplasty for Dialysis Access
- Risks and Limitations
- Aftercare and Monitoring
Understanding Dialysis Access
Dialysis requires a dependable way for blood to leave and return to the body. This is achieved through dialysis access, which serves as the “entry point” for treatment. There are three main types of access:
- Arteriovenous (AV) fistula: Created by surgically connecting an artery to a vein, usually in the arm. This is the preferred method because it provides strong, long-lasting blood flow with fewer complications.
- Arteriovenous (AV) graft: Involves connecting an artery and vein with a synthetic tube. Grafts are often used when veins are not suitable for fistula creation.
- Central venous catheter: A temporary solution where a tube is placed into a large vein. Catheters are prone to infection and clotting and are generally avoided for long-term use.
While fistulas and grafts are the best long-term access options, they are not without challenges. Over time, scarring, narrowing (stenosis), or clotting can occur, which can reduce blood flow and compromise dialysis treatments. Without timely intervention, these problems may lead to access failure and the need for surgical revision or catheter placement.
What Is Angioplasty?
Angioplasty is a minimally invasive procedure designed to restore proper blood flow when a dialysis access becomes narrowed. Using imaging guidance, your Berwyn kidney specialist threads a thin catheter into the blood vessel and positions a small balloon at the site of the narrowing. Once in place, the balloon is gently inflated to stretch the vessel and widen the pathway for blood flow.
Unlike angioplasty performed on the heart, which targets coronary arteries, dialysis access angioplasty specifically treats narrowing within AV fistulas and grafts. Sometimes, if the narrowing is severe or keeps coming back, a stent (a small mesh tube) may also be placed to help keep the vessel open.
This procedure is performed on an outpatient basis, is generally well-tolerated, and often allows patients to resume dialysis treatments the same day. By quickly and effectively reopening narrowed vessels, angioplasty plays a crucial role in maintaining the function of dialysis access.
Why Angioplasty Is Needed for Dialysis Patients
Dialysis patients often face challenges with their fistulas or grafts over time. One of the most common problems is stenosis, or narrowing of the blood vessels. This can be caused by:
- Scar tissue formation at the site of repeated needle insertions.
- Vessel injury from high-pressure blood flow.
- Natural healing response of the body that thickens vessel walls.
When narrowing occurs, the dialysis machine may not be able to filter enough blood, leading to less effective treatments. Patients might notice symptoms such as:
- Prolonged bleeding after dialysis.
- Swelling in the arm or hand.
- Difficulty inserting needles.
- Dialysis machine alarms due to poor blood flow.
Without timely treatment, stenosis can progress to a clot, completely blocking the access. This may result in missed treatments, emergency procedures, or the need for new access creation. Angioplasty helps prevent these complications by restoring flow early and extending the life of the access.
The Procedure: Step by Step
Angioplasty for dialysis access is a straightforward, minimally invasive procedure that typically takes less than an hour. Here’s what patients can expect:
- Preparation: The access is evaluated using imaging studies, such as a fistulogram or angiogram, which highlight areas of narrowing or blockage.
- Local anesthesia: Patients are given numbing medication at the insertion site. Sedation may also be provided for comfort.
- Catheter insertion: A thin tube (catheter) is guided into the narrowed area of the fistula or graft.
- Balloon inflation: A small balloon attached to the catheter is carefully inflated, stretching the narrowed vessel and restoring blood flow.
- Stent placement (if needed): If the narrowing is severe or likely to recur, a stent may be placed to help keep the vessel open.
- Recovery: Most patients can return home the same day and resume dialysis shortly after the procedure.
This step-by-step approach ensures that dialysis access remains usable, often without the need for major surgery.
Benefits of Angioplasty for Dialysis Access
Angioplasty offers multiple advantages for patients who rely on dialysis:
- Restores adequate blood flow: By widening narrowed vessels, angioplasty ensures the dialysis machine can filter blood effectively.
- Extends the life of access sites: A functioning fistula or graft can last longer with timely intervention, reducing the need for new surgeries.
- Reduces reliance on catheters: Maintaining fistulas and grafts helps patients avoid central venous catheters, which carry higher risks of infection and clotting.
- Minimally invasive: Angioplasty does not require large incisions or extended hospital stays, making it easier for patients to recover quickly.
- Immediate improvement: In many cases, patients can feel the difference in access function right away and resume dialysis treatments without interruption.
These benefits make angioplasty one of the most effective tools in preserving long-term dialysis access.
Risks and Limitations
While angioplasty is generally safe and effective, it is important to understand the potential risks and limitations:
- Vessel injury: The procedure can sometimes cause damage to the blood vessel, though this is uncommon.
- Bleeding or infection: As with any procedure involving blood vessels, there is a small risk of bleeding or infection.
- Re-narrowing (restenosis): Narrowing may return over time, requiring repeat angioplasty or additional procedures.
- Not a permanent solution: While angioplasty can extend the life of access sites, it does not cure the underlying issue, and ongoing monitoring is necessary.
Despite these risks, angioplasty remains a critical intervention because it often prevents complete access failure and reduces the need for more invasive surgical options.
Aftercare and Monitoring
After an angioplasty, proper care and routine monitoring are key to keeping dialysis access healthy. Patients are encouraged to:
- Check the thrill and bruit daily: Feeling or listening for the vibration and “whooshing” sound ensures the access is still working properly.
- Watch for changes: Report swelling, redness, pain, or prolonged bleeding to the dialysis team immediately.
- Follow access care guidelines: Avoid tight clothing, heavy lifting with the access arm, or sleeping on the access side.
- Attend regular checkups: Routine evaluations by your Berwyn nephrologist or vascular specialist help detect narrowing early before it leads to complications.
By staying proactive, patients can protect their access and reduce the chances of repeated interventions.
Conclusion
Angioplasty plays an essential role in preserving dialysis access, helping patients maintain reliable treatments and avoid unnecessary interruptions. By restoring blood flow, it extends the life of fistulas and grafts, reduces the need for catheters, and improves overall dialysis outcomes. If you are on dialysis and notice changes in your access site, such as swelling, prolonged bleeding, or difficulty during treatment, don’t wait. Early evaluation and intervention can make a big difference in keeping your access working properly.
At Nephrology Associates of Northern Illinois and Indiana (NANI), our specialists are experienced in protecting and preserving dialysis access through advanced treatments like angioplasty. With clinics across Illinois, Indiana, and New Jersey, we provide comprehensive kidney care that keeps your dialysis running smoothly and your health a top priority.
If you’re experiencing issues with your fistula or graft, don’t wait—contact NANI today to schedule an access evaluation and learn how our team can help keep your dialysis lifeline strong.
