Reliable hemodialysis depends on a well-functioning vascular access. Soris Pain & Vascular Institute manages arteriovenous (AV) fistulas and grafts throughout their lifespan, evaluating access that is slow to mature, losing flow, or failing so patients can continue dialysis without interruption.
Our physicians use ultrasound and image-guided angiography to find the narrowing or clot behind a struggling access, then treat it in the same outpatient session when appropriate.
Longer bleeding times after needle removal, difficulty reaching prescribed blood-pump speeds, or frequent dialysis-machine pressure alarms can signal a narrowing within the fistula or graft. Soris Pain & Vascular Institute evaluates these findings before the access fails.
A weakened or absent thrill (the vibration felt over the access) or a change in the bruit (the sound heard through a stethoscope) may indicate the access is losing flow and warrants evaluation.
Arm swelling, a pulsatile access, or bleeding that is difficult to stop after a session can reflect an outflow obstruction. Prompt assessment helps protect the access.
The most common reason a fistula or graft struggles is narrowing from tissue build-up within the vein or graft wall that restricts flow. Repeated needle access and turbulent blood flow contribute over time.
When a narrowing goes untreated, blood flow can slow enough to clot, abruptly stopping dialysis through that access. Grafts are generally more prone to clotting than native fistulas.
Some new fistulas do not enlarge enough to support reliable needle access. Early evaluation identifies correctable problems such as a competing side branch or an inflow narrowing.
Fistulogram combines imaging with balloon angioplasty to open a narrowed native fistula in the same session, restoring flow for dialysis.
Graftogram evaluates a failing AV graft and treats the responsible narrowing with angioplasty during the same visit.
Declot removes clot from a fistula or graft that has stopped working and treats the underlying narrowing so dialysis can resume.
Related Dialysis Access Services
Dialysis access care at Soris Pain & Vascular Institute spans catheter placement, catheter management, and access salvage. Patients receive coordinated care to keep hemodialysis on schedule.
FAQ
Contact your care team promptly. Soris Pain & Vascular Institute evaluates a clotted or failing access, often restoring flow the same day with a declot or angioplasty procedure so you can return to your dialysis schedule.
Most fistulogram, graftogram, and declot procedures are performed on an outpatient basis using local anesthesia with light sedation. Patients typically go home the same day.
It varies by patient and access type. Some accesses need periodic angioplasty to stay open. Your physician monitors flow and treats narrowings before they cause a complete failure.
Board-certified physicians bringing hospital-level, minimally invasive interventional procedures to outpatient centers.
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