Severe narrowing of
the superior vena
cava. This blockage
was resulting in
severe face and
arm swelling.

Same patient as
above, following
angioplasty of the
vena cava. Face and
arm swelling were
significantly
improved.

For patients with kidney failure, dialysis is a matter of life-and-death. Hemodialysis is the best method for clearing the toxins from the blood. To accomplish this, a large volume of blood must be removed from the body, run through the dialysis machine, and returned to the body.

This is best accomplished by using a surgically created fistula or shunt between the arteries and veins, which results in a high rate of flow through the shunt, as is needed for dialysis. While these shunts are vital for successful dialysis, they are often difficult to keep open.

This difficulty is related to the body's response to this high flow state in the veins. In response to this flow, a process of scar tissue formation occurs (intimal hyperplasia) that closes these veins, causing the grafts or fistulas to function poorly or to even clot.

Interventional radiologists play an important role, in conjunction with the surgeons who place these shunts and the nephrologists who perform the dialysis, in managing these shunts and the integrity of the veins on which a dialysis patient is dependent.
 

Following is a description of some procedures RCT physicians perform to preserve the function of a dialysis graft or fistula, which is of vital importance to the dialysis patient.

• Venous Angioplasty


In this procedure, the narrowed portion of the vein is opened to improve and preserve the function of a failing graft or fistula.

The interventional radiologist guides a wire trough the vein, across the narrowing while using a x-ray machine (fluoroscope) to see the vein and wire as he works. Over this wire, a small tube (catheter) with an attached balloon is advanced to the site of the narrowing. The balloon is then inflated to open the narrowed vein.

This procedure is performed through a small needle puncture made into the vein or graft, similar to those made during routine dialysis. No hospital stay is required following this procedure.
 
 

• Graft Thrombolysis


If a graft becomes clotted (thrombosed), the interventional radiologist can restore flow through the graft by removing the clot from the graft.

This is done by making one or two small needle punctures into the graft as is done during routine dialysis. Drugs that dissolve (lyse) the blood clot are then injected into the graft to remove the clot.

The narrowing in the vein, which is the cause of a graft clotting approximately 90 percent of the time, is then treated with an angioplasty.
 

 
• Venous Thrombolysis

 
• Dialysis Catheter Placement 

• Poorly functioning or clotted (thrombosed) dialysis grafts or fistulas

Narrowed veins which obstruct or slow the flow of blood.

The vein draining a
dialysis fistula,
showing a severe
narrowing, before
treatment. This was
causing problems
with dialysis.

The same vein as
shown in the above
image, following
balloon angioplasty.

Dialysis graft with no
flow of x-ray dye due
to the fact that it is
filled with blood clot.
 

Dialysis graft with
restored flow
(filled with x-ray dye)
following treatment
with thrombolytic
medication to
dissolve the clot
which was
previously present.