FISTULOGRAM

When you’re on dialysis, your access site is your lifeline — and keeping it open and functional is critical. At Prospero Vascular, we offer fistulogram procedures as part of our comprehensive outpatient dialysis access care. A fistulogram is a minimally invasive, image-guided diagnostic test that allows our vascular specialists to assess, diagnose, and treat access issues before they become major complications.

If you’re experiencing problems with your arteriovenous (AV) fistula or graft, a fistulogram may be the most effective and efficient way to identify the problem and resolve it in a single visit.

What Is a Fistulogram?

A fistulogram, also known as an access angiogram, is a specialized imaging test that uses contrast dye and real-time X-ray (fluoroscopy) to evaluate blood flow through your dialysis access. It is typically performed when your dialysis center notices reduced blood flow, prolonged bleeding, or other signs that your access site may be narrowed (stenosed), clotted, or otherwise dysfunctional.

At Prospero Vascular, we perform fistulograms on an outpatient basis using local anesthesia and light sedation. In many cases, if we find a problem during the procedure, we can treat it immediately, often with angioplasty, thrombectomy, or stent placement — all in the same visit.

Why Fistulograms Matter for Dialysis Patients

Dialysis patients use their AV fistula or graft multiple times each week. These access sites are subjected to repeated needle punctures and high blood flow rates, which can lead to:

A fistulogram is the gold standard for catching these issues early, ensuring your access site functions properly and reducing the risk of missed dialysis sessions or emergency procedures.

When Is a Fistulogram Needed?

You or your dialysis team might suspect an issue with your AV fistula or graft based on certain symptoms or measurements. Common signs that a fistulogram may be needed include:

• Difficulty with needle placement
  
• Prolonged bleeding after dialysis sessions
  
• A change in the thrill or bruit (the vibration or sound over the access)
  
• Decreased blood flow during dialysis
  
• Swelling in the access arm or hand
  
• Recurring clots or infections
  
• Elevated venous pressures during dialysis
  

Your nephrologist or dialysis nurse may refer you for a fistulogram based on these clinical signs, or you can self-refer if you’re noticing unusual symptoms.

What to Expect During a Fistulogram

At Prospero Vascular, your comfort and safety are our top priorities. The fistulogram procedure is quick, minimally invasive, and typically takes 30 to 60 minutes.

Step 1: Pre-Procedure Evaluation

• Our vascular specialist will review your dialysis history, symptoms, and any prior imaging.
  
• We’ll check vital signs and ask about any allergies, especially to iodine or contrast dye.
  
• You’ll receive local anesthesia and mild IV sedation to help you relax.
  

Step 2: Catheter Insertion

• A tiny needle puncture is made, usually in the arm where your access is located.
  
• A thin catheter is inserted into your fistula or graft under ultrasound and fluoroscopic guidance.
  

Step 3: Contrast Injection and Imaging

• A small amount of iodine-based contrast dye is injected to make the blood vessels visible under X-ray.
  
• The real-time imaging helps us observe how blood flows through your access and detect any abnormalities.
  

Step 4: Diagnosis and Treatment (If Needed)

• If a narrowing, blockage, or clot is found, we can often treat it right away:
  
  • Angioplasty: A balloon is used to widen narrowed areas.
    
  • Thrombectomy: Clots are removed using special catheters.
    
  • Stent placement: A small mesh tube is inserted to hold the vessel open.
    

Step 5: Recovery and Discharge

• You’ll rest in our recovery area for 1–2 hours for observation.
  
• Most patients go home the same day with minimal restrictions.
  

Benefits of a Fistulogram

Fistulograms offer several key advantages:

✅ Accurate Diagnosis – Pinpoint exactly where and why your access is malfunctioning.
✅ Real-Time Imaging – Live X-ray lets us visualize the entire access circuit.
✅ On-the-Spot Treatment – Many problems can be resolved during the same visit.
✅ Avoid Hospitalization – No need for inpatient care or emergency department visits.
✅ Prevent Access Failure – Early intervention keeps your access functional and reliable.
✅ Outpatient Setting – Performed in a comfortable, efficient, same-day facility.

When performed by vascular specialists in an outpatient setting, a fistulogram can significantly reduce complications, cost, and inconvenience.

Who Is a Candidate for a Fistulogram?

You may be a good candidate for a fistulogram if you:

• Are currently receiving hemodialysis via an AV fistula or graft
  
• Have been told your access isn’t working well
  
• Are experiencing symptoms of access dysfunction
  
• Have a history of access stenosis or clotting
  
• Are being evaluated for access maturation
  
• Need routine monitoring of a long-standing access
  

Fistulograms are generally safe for most patients, including those with chronic conditions such as diabetes, hypertension, and heart disease.

Risks and Safety

Fistulograms are very safe and low-risk, especially when performed in an accredited outpatient center like Prospero Vascular. However, as with any medical procedure, there are some potential risks, including:

• Allergic reaction to contrast dye
  
• Bleeding or bruising at the puncture site
  
• Infection (rare)
  
• Temporary discomfort or swelling
  
• Kidney strain from contrast dye (especially in patients with residual kidney function)
  

We take every precaution to minimize these risks, including using the lowest dose of contrast possible, careful sterile technique, and advanced imaging technology. If you have a known allergy or compromised kidney function, we’ll adjust the protocol accordingly.

Long-Term Dialysis Access Management

At Prospero Vascular, we don’t just perform procedures — we partner with you and your nephrology team for long-term access management. Fistulograms are part of a broader strategy to ensure:

• Consistent dialysis sessions
  
• Reduced risk of catheter use
  
• Longer lifespan of your access
  
• Lower rates of hospitalization and infection
  

We track your results, provide follow-up care, and work closely with your dialysis center to monitor your access over time

FAQs About Fistulograms

Will a fistulogram hurt?
Most patients feel little to no pain during the procedure. You’ll receive local anesthesia and light sedation to keep you comfortable.

Can I eat before a fistulogram?
We typically ask patients to fast for a few hours before the procedure, especially if sedation will be used.

How long will I be at the clinic?
Expect to be at Prospero Vascular for about 2–3 hours total, including prep, procedure, and recovery.

Can I drive myself home afterward?
If you receive sedation, you’ll need someone to drive you home. If no sedation is used, you may be able to drive yourself — we’ll confirm in advance.

Is this covered by insurance?
Yes. Fistulograms are usually covered by Medicare and most private insurance plans. Our team will verify coverage and explain any costs ahead of time.

How often should I have a fistulogram?
That depends on your access history and current symptoms. Some patients need routine monitoring every 6–12 months, while others only need a fistulogram if issues arise.