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A fistula is a surgical connection between an artery and a vein created to provide enough blood flow at the appropriate pressure to make hemodialysis effective and possible.

A fistulagram is an X-ray study of your fistulas to detect a clot or narrowing. Early detection and treatment can improve your fistula’s performance and limit future complications.

Why Do I Need a Fistulagram?

You may be having symptoms that suggest a blockage of your fistula.

For example:

  • A blockage in your fistula may cause high venous pressures during your dialysis.
  • If you cannot feel a thrill with your fistula, the fistula may be completely blocked.

The blood vessels that are connected to the fistula are subjected to higher rates of blood flow and pressure. Often, this results in the formation of scar tissue, causing narrowing of the fistula or blood vessels. A fistulagram can identify exactly where the artery or vein is blocked, how severe the blockage is, and what is causing the blockage.

Preparing for a Fistulagram

If you are already a patient in the hospital, your doctors and nurses will provide you with instructions. If this will be done on an outpatient basis, you should:

  • Have no solid food within 6 hours of your scheduled appointment; you may drink clear liquids (such as apple, grape, cranberry juices, soda, water and tea) up to 2 hours before the procedure.
  • Let us know right away if you take glucophage, insulin or a blood thinner so that we can adjust your dosage. Take your other medications as usual.
  • Let us know if you have an allergy to X-ray (contrast) dye so that we can take the necessary precautions.
  • Bring a list of all of your medications or your medication bottles with you on the day of the procedure.
  • Get someone to drive you home.

During a Fistulagram

We insert a needle into your fistula, and you will feel warm in your hand, arm and chest. You may get a metallic taste in your mouth. These sensations only last 10-15 seconds. Several x-ray pictures are needed to complete the test.

If there is an area of narrowing or clot present in the blood vessel that can be helped by balloon angioplasty, stent, clot dissolving medications or a clot-breaking device, this may be done at this time. 

A fistulagram usually takes 2-3 hours to complete.

Fistulagram Risks

With modern techniques, a fistulagram is a relatively safe procedure, however, the procedure is not totally risk-free.

  • Placing a catheter in your artery can damage it. Even when it has not been damaged, you may have a bruise or small lump where the catheter was inserted. The bruise or lump may be sore, but will go away in a few days.
  • A few patients will become sick from the contrast dye.

A member of the interventional radiology team will discuss the exact risks of your fistulagram with you in detail before your procedure begins.

After the Fistulagram

Have Your Sutures Removed

Sometimes sutures are placed in the skin around the puncture sites because of the possibility of prolonged bleeding. These are visible blue or black threads overlying the puncture zones in your dialysis graft. These sutures only need to remain in place long enough for the puncture sites to heal. At your next dialysis session, please ask your dialysis nurse to remove these sutures. It is very important that you have these sutures removed in 2-3 days.

Monitor Your Fistula

Monitor your fistula frequently. A good thrill in your fistula indicates good blood flow through the vein. A good pulse in your fistula indicates good blood flow through the artery. You are the best person to judge how well your fistula is working. Also, have the dialysis nurse call us if they have difficulties using your fistula for dialysis.


Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.