New treatment option for Blocked AV Fistula – Balloon angioplasty

Arteriovenous (AV) Fistula is a communication made between an artery and a vein, where bypassing the capillaries blood flows directly from artery to vein made for hemodialysis in End Stage Renal Disease (ESRD).

In one of the first instances in Rajasthan, Dr. Devendra Sharma, Director of Kidney Transplant & Urology Department, RBH, came across a case of blocked AV Fistula. 57 years old female was on maintenance HD through left Brachiocephalic AV fistula. She had one episode of hypotension and ICU admission for the same. After that her fistula stop functioning.

57 years old female was admitted to RBH with a complaint of sudden stoppage of AV fistula. Already she was suffering from a known case of end-stage renal disease and she had been treated with maintenance hemodialysis at another hospital in Jaipur. Due to her other comorbidities like low blood pressure and hypertension she had a fistula blockage suddenly. A thrombosis or clotted blood formed adding further to her woe and causing complete obstruction. With such blockage her regular dialysis suffered and opening of the AV fistula was required. Initially, when she came to RBH, Dr. Sharma had put a catheter for thrombolysis. However, after two days her issue wasn’t resolved. Finally, Dr. Sharma decided to go for a special procedure with balloon dialysis and angioplasty, through which her thrombus was removed.

Commenting on patient’s condition Dr. Sharma states, “Within first two days of patient’s admission, we conducted an intensive Doppler study of Brachiocephalic AV fistula, where we found that there was a thrombus of 2-3 cm in the vein. We administered STK infusion on the patient with the help of Dr. R D Pandey, cardiologist at RBH. Even after 48 hours of infusion there was no improvement in blood flow, so we took her into Cath lab and performed a balloon angioplasty. The blood flow in fistula became normal as we removed the thrombus. Presently, she is undergoing regular dialysis like before with same fistula and the blood flow remains constant.”

Arteriovenous fistula can lead to much complications like heart failure, blood clot, bleeding among other problems, if not treated properly on time. Early detection always makes treatment easy and recovery faster. Since, this patient had advanced stage kidney disease, AV was surgically created for dialysis purpose and blocking of that AV made her condition critical. Since dialysis is the lifeline for good health in a kidney patient, taking care of AV is the most important task. Post-procedure healing can take some time, but well-functioning of AV is needed to provide good blood flow to the dialyzer. Hence, constant clinical supervision from doctors is necessary.

Contrary to the treatment methodology suggested to her at the previous hospital, there was no need for a new fistula foundation as Dr. Sharma opted for repairing the existing fistula. Without compromising her regular dialysis which was crucial to her condition, Dr. Sharma performed the procedure with the most advanced technology available at RBH. Under Dr. Sharma and Dr. Pandey’s expert guidance, the patient received a highly personalized treatment where her specific issues where highlighted to adopt the correct treatment methodology rather than determining a generic one. The patient has recovered well and her dialysis treatment is completely stable.

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