FISTULAGRAMS – PROCEDURAL CONSIDERATIONS

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  1. Antibiotics: Usually not
    1. Given if patient has stent graft (optional)
  2. Sheath size:
    1. Central intervention: 7F (>10mm tx)
    2. Other interventions: 6F
  3. Angioplasty of fistula stenosis:
    1. Oversize ~10-20%
  4. Balloon sizes (guides) – 
    1. Arterial anastomosis: 5mm(max)
      1. Juxta-anastomosis: 5 mm
    2. AVG: 6-7 mm
    3. Subclavian vein: 12 mm
    4. Brachiocephalic vein: 14 mm
    5. SVC: 18 mm
  5. Angioplasty length – 5mm “flank” stenosis
    1. Usu high pressure balloon
  6. Angioplasty order —>Start Central stenosis
  7. Angioplasty 1-2 min duration
  8. Covered Stents
    1. Indicated for early restenosis (< 3 months)
    2. AVG at venous anastomotic stensosis
      1. RCT data covered stent > POBA
    3. Examples
      1. Viabahn
      2. Fluency
  9. Suturing sheath removal (optional)
    1. 2-0 monofilament (3-4 bites)
    2. Remove in 2-3 days ( next dialysis section)
  10. DASS – MILLER Procedure (PDF)