Fistulagram

[Shaks24]

So I've been doing PD for 4 years now. When I got my catheter placed the surgeon convinced to get a fistula placed at the same time as back up in case of complications with PD. Recently my fistula hand has turned red and swollen to the point of my skin on fingers splitting at the joints. Today they scanned my arm and determined I am not getting blood flow to my fingers. They scheduled me for a fistulagram on Monday morning and said they could decide what was best to do after reviewing the fistulagram. The said they may have to tie off the fistula and it would die away. I guess they won't know until the fistulagram is done. Has anyone else been through this process. I am hoping they just find some blockage they can open up to keep the fistula. I don't know what to expect. 

[Paul]

Not been through it myself, but a woman at our clinic has. If I remember correctly it required a little surgery to fix, but it was fixable in her case.

[Michael Murphy]

Fistula gram is the same as a angiogram.  They insert die into the fisuls X-ray the fistula and from the X-ray get a good idea on what’s going on.  This  may lead fo a fistulaplasty in which a tube is inserted into the fistula and inflated to clear any blockages.  The only down side is the dye used is not friendly to kidneys and you should ask that the dye used is minimized.  I had the procedure done 6 months after my fistula was created and it was not painful or inconvenient.

[PrimeTimer]

So I've been doing PD for 4 years now. When I got my catheter placed the surgeon convinced to get a fistula placed at the same time as back up in case of complications with PD. Recently my fistula hand has turned red and swollen to the point of my skin on fingers splitting at the joints. Today they scanned my arm and determined I am not getting blood flow to my fingers. They scheduled me for a fistulagram on Monday morning and said they could decide what was best to do after reviewing the fistulagram. The said they may have to tie off the fistula and it would die away. I guess they won't know until the fistulagram is done. Has anyone else been through this process. I am hoping they just find some blockage they can open up to keep the fistula. I don't know what to expect. 

Shaks24: I would think they'd constitute this an emergency and get the blood flowing in your arm and fingers again ASAP. Hope you come back and let us know what they decided to do for you. Hopefully you can keep your fistula (and your fingers!). Wish you well.

[Charlie B53]

There are few few 'dyes' to choose from, the Dr will decide which may be needed in your case.  Sometimes, as with my last couple of heart angios, Dr used CO2 instead of dye.  I was surprised as I always thought any 'bubbles' in the system could be deadly.  Dr laughed and told me NOT CO2.  It is a natural and is very easily dissolved and carried around the blood system, shows up well as 'empty spaces' on X-ray,, will not cause any clotting problems or anything, and is very easily 'blown off' out through the lungs.

Wow!  Whoever thought of this had a great idea!

Hopefully your hand problem is simply low circulation that may be improved with a simple stent, or a clamp to reduce flow through your fistula.  The test will show what and where and dr will know how to proceed.

[Shaks24]

Prime Timer, I considered going to the ER but after talking to my clinic decided it would be best to see my surgeon (same guy that did my catheter and fistula) No telling what or who you get at the ER. It was a very painful wait as my hand was very discolored and my fingers were splitting at the seams on the tops and the sides from the swelling and very dry skin. Anyhow I was in early on Monday with the surgeon. They gave me the dye injection and then examined the fistula with the xray machine they use. This was done under local anesthesia. He immediately  identified a large vein that truncated off of the fistula and he said it was definitely pulling blood away from my hand and fingers. He then told me that he would ligate(tie off) the vein right then and told me the biggest risk of the procedure is infection. I told him to go for it. So this was done on Monday. It seems to have worked but its hard to tell for sure because my arm is sore from the procedure and my fingers still hurt from all the sores caused by the swelling and splitting at the joints. They did do a scan after the procedure and the surgeon was happy with the blood flow. I go back on the 25th to have the stitches removed and have my arm and hand scanned again. It was about a 3 inch incision cut diagonally upwards across my original fistula surgery scar.     I think I was on the operating table for about an hour or so. The funny thing is this same surgical group scans my fistula once a year. I told the tech that does the scan last July that I had a bit of swelling and numbness in two fingers. She mentioned this vein that grew off the fistula but said all my flows were good and it was not a problem. I guess she was wrong. LOL

[Shaks24]

For anyone wondering about the prep for this procedure there really is none. You don't have to fast the night before or stop taking any of your meds with the exception of blood thinners if you are on them because it was local anesthesia. You go in and they take all your vitals. You disrobe from head to waist. They even made me take off 2 gold chains I wear. One was given me from my deceased mom and the other from my deceased dad. They hook you up to a BP monitor on your leg and an oxygen monitor on your finger. They cover you up with sterile blankets with only the target arm sticking out and I think clamped to a side support. They scrub the heck out of the target arm with some yellow stuff that is hard to wash away. I never even saw the surgeons face cause the blankets covered my face. LOL The only pain I felt was a pinch when he stuck the fistula with the local anesthesia. Other than that I felt pressure and pulling and tugging but no pain at all.  Upon discharge they tell you you can resume normal activity in 2 days and list things to look out for. They did say that the fistula could not be used yet and that they would remove the stitches and for the  PD clinic not to. That was pretty much it. I guess they will confirm that the fistula is ready to use on the 25th although I have yet to use mine for dialysis. My PD catheter has been a good one from day one and so far no infections in my peritoneum after 4 years of use.

[PrimeTimer]

Glad your vascular guy was able to save your fistula! No doubt the whole ordeal was nerve-wracking. Sounds like you were able to keep your head on tho in a situation that could've easily went south. Not so sure I could. My husband's fistula once blew while he was in the hospital for an infection and luckily they had a good vascular surgeon available in the nite but, like you he prefers to see the same vascular guys (he has 2) whenever something may be amiss. It's all those little balloon jobs (angioplasties) they do that keep his fistula alive. Hope you don't think I was scolding you for not going to the ER. It's just a scary thought to know that people who have fistula's are at risk. Took me a long time to get use to my husband having one in his arm and after more than 3 years, I still worry. We both do. Glad you had your clinic check it out. Thanks so much for sharing your experience and the procedure they performed on you. As you know, this site is our "go to" place for questions, answers and everything in-between. You done good! Hope they give you good news at your follow-up. 

[Shaks24]

Thank you Prime Timer. Today is actually the first day my arm has felt better. I am trying to not take anymore of the pain med he prescribed and so far so good. Its hard to set up the PD Cycler with only one arm functioning well. Specially when both your arm and your fingers are sore. Washing the hand with antibacterial soap and using hand cleaner that's 80% alcohol is torture. LOL  Last night it was a bit easier.

[PrimeTimer]

Backing off on pain meds is always a good idea so long as you are not left writhing in pain. Otherwise pain meds are necessary for the body to rest and therefore, heal! As for being a one-arm bandit right now, haven't got any suggestions. Maybe get yourself a "Trunk Monkey" like you see in those old tv commercials. Google "Trunk Monkey" youtubes...lol...well hey, they do say laughter is the best medicine...lol...