Key facts
- What it covers: keeping AV fistulas and grafts — the vascular access used for haemodialysis — working properly over time.
- Main procedures: fistulogram (diagnostic imaging), balloon angioplasty for narrowing, and thrombectomy for a clotted access.
- Why it matters: a well-functioning access is essential for effective dialysis — access problems are one of the most common reasons dialysis patients need intervention.
- What to expect: typically a day procedure, often performed urgently if the access has clotted.
Patients on haemodialysis rely on a surgically created vascular access — usually an arteriovenous (AV) fistula or graft — to allow blood to be removed, filtered, and returned during each dialysis session. Because of the altered blood flow through these accesses, they're prone to developing narrowing (stenosis) over time, which can reduce dialysis efficiency or lead to complete blockage if not identified and treated. Dialysis access management covers the diagnostic and treatment procedures that keep this access working.
Fistulogram
A fistulogram is a contrast X-ray study of the fistula or graft, used to identify any areas of narrowing along its length or in the veins draining it. It's often performed when a dialysis unit notices signs the access isn't performing as well as it should — reduced flow rates, difficulty with needle placement, or prolonged bleeding after dialysis.
Angioplasty and stenting
Where a fistulogram identifies a significant narrowing, balloon angioplasty is used to open it up from within — a balloon catheter is positioned across the narrowed segment and inflated to stretch it open. In some cases, particularly where narrowing recurs quickly, a stent may be placed to help keep the vessel open longer-term.
Thrombectomy (declotting)
If an access clots off completely, it can often be treated urgently with catheter-based techniques to remove the clot and restore flow, combined with angioplasty to address the underlying narrowing that likely caused the clot in the first place. Prompt treatment gives the best chance of salvaging the access rather than needing a new one created surgically.
Why ongoing surveillance matters
Because narrowing tends to recur, many dialysis patients need periodic angioplasty over the life of their access — this is a normal, expected part of maintaining a fistula or graft rather than a sign something has gone wrong. Regular monitoring by the dialysis unit, with timely referral for imaging and intervention, helps maximise how long an access continues to function well.
Common questions
What is a fistulogram?
A fistulogram is an X-ray study using contrast dye to visualise a dialysis fistula or graft, identifying any narrowing (stenosis) or blockage that's affecting how well it works for dialysis.
Why does dialysis access need ongoing maintenance?
AV fistulas and grafts are prone to developing narrowing over time due to the altered blood flow through them, which can reduce dialysis efficiency or lead to clotting if not identified and treated.
What happens if a fistula or graft clots off?
A clotted access can often be treated urgently with catheter-based clot removal (thrombectomy) combined with angioplasty to address the underlying narrowing that caused the clot, restoring the access for dialysis use.
Next step
Concerned about your dialysis access?
Ask your renal team about a referral, or get in touch directly to discuss suitability.
Get in touch