Improving Dialysis – Fistula Efficiency: Plan B

Time to look at my fistula again. It’s only about 6 weeks since my last fistulagram and ballooning, and while the efficiency improved initially, it has gradually fallen again. So time for Plan B.

Plan B is another fistulagram, this time to be completed by a vascular surgeon rather than a radiologist. If  he finds a stenosis (a narrowing or choke point) in the fistula he operates under a local anaesthetic (which is how the initial one was created 14 short years ago).

There are several ways he can fix it:

1. Expand the anastomosis (vein – artery join) to absorb the stenosis,

2. Create a  new, vein-to-vein anastomosis (merging a narrow bit into a fat bit of the same vein) to remove the narrowing,

3. Patch the vein,

4. Shorten the vein, or

5. Insert an artificial tube (graft).

Since the procedure involves only a short segment of vein, the fistula can be used pretty well straight after the operation (keeping clear of the new work until it has healed).

My fistula, ready for Plan B

Warning: self diagnosis following: I think that the stenosis is very close to the anastomosis, so it is likely he’ll do no. 1, expand the anastomosis to absorb the narrowing (see pic).

So, let’s see what happens on Friday.

In the interim, I have been trying to improve the efficiency of my BigD sessions by placing the needles as far as possible from each other to reduce the possibility of recirculation. To do this, I have revived an old venous needle entry site on my bicep, which is about 15 cm (6 in) from my usual venous needle site. It seems to be working, but it is less comfortable and I’m looking forward to the return of ‘old reliable’ next week.

I’ll let you know how it goes.

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