A fistulogram is a test to look for abnormal areas in the dialysis graft or arterio-venous fistula that may be causing problems with dialysis. These may include areas of blocked veins or arteries (occlusion), abnormal narrowing (stenosis), or areas of abnormal enlargement (pseudoaneurysm). A fistulogram is safe, commonly performed procedure. Patients will be asked not to eat for six hours prior to the minimally invasive test, which lasts less than one hour. Sedation and pain control is available if needed. A small tube (catheter) is placed in the graft. X-ray dye is injected and radiographic pictures (the fistulogram) are taken of the area. The pressure in the graft is measured because high pressures can alert us to significant abnormalities. If abnormal narrowing is seen, it is usually treated by stretching the narrowed area open with the inflation of a small balloon in the graft (angioplasty). If the angioplasty is unsuccessful, the graft will need to be opened by a surgeon. Sometimes a stent may be placed to help keep the narrowed area open. At the end of the procedure the catheter is removed and pressure is held over the puncture site.It is important to have a responsible adult to drive you home
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UAB Hospital first in Alabama to offer first-of-its-kind dissolving heart stent
The interventional cardiology team at UAB Hospital recently added to its longstanding reputation as a pioneer in the development and implementation of stents by becoming the first in Alabama to offer patients with coronary artery disease a new treatment option that disappears over time.
On July 20, Massoud Leesar, M.D., a professor in UAB’s Division of Cardiovascular Disease, implanted a patient with the world’s first FDA-approved dissolving heart stent for the first time in Alabama. The Absorb bioresorbable vascular coronary stent is a major advance in the treatment of coronary heart disease, which is responsible for about 370,000 deaths each year in the United States, according to the National Heart, Lung, and Blood Institute. This type of stent has been in the making for nearly 15 years.
While stents are traditionally made of metal, the Absorb stent is made of a naturally dissolving material called polylactide, similar to dissolving stitches or sutures.
“Since the Absorb stent gradually dissolves, this may be a safer long-term option for patients because metal stents can clot and occlude the artery,” Leesar said.
The stent is placed into the artery on a balloon at the end of a thin flexible tube, much like the procedure used to place bare metal and drug eluting coronary stents. It is then expanded by inflating the balloon that pushes the plaque against the artery wall to enable greater blood flow. The balloon is removed, leaving the Absorb stent to slowly release medication to the diseased area. With blood flow restored, the stent begins dissolving.
After Absorb dissolves, it allows the artery to pulse and flex naturally. It may also reduce the risk of future blockages that occur with metallic stents, and makes it easier for doctors to offer additional interventions in the future if necessary. During the dissolving period, Absorb metabolizes into water and carbon dioxide, two elements that occur naturally in the body. All that remain in the artery are two pairs of tiny metallic markers that enable a physician to see where the device was placed. After three years, the device is completely dissolved and the vessel can remain open and pulsate on its own.
Calvin Burnett of Albertville, Alabama, is the first patient in the state to receive the new Absorb stent. After Burnett was diagnosed with rectal cancer in September 2015, his oncologist recommended he see a cardiologist at UAB following complaints of tightness in his chest.
“I’ve always been kind of physically active, so this kind of threw me for a loop,” Burnett said.
Two days after his stress test, an Absorb stent was placed. Burnett says he is grateful that medicine has come so far.
“I think this is such a great thing,” he said. “I’m looking forward to getting back to riding horses.”
Burnett says he could not imagine having his procedure done anywhere other than at UAB.
To ensure optimal patient selection and implant technique, UAB’s interventional cardiology team underwent extensive training on the new device.
“One of the advantages of this new stent is that the risk of a metal stent’s suddenly clotting is a major issue long-term,” Leesar said. “Since the new stent dissolves over time, this risk can be eliminated, and the vessel has the potential to be open more than to before with the stent.”
Currently, patients who receive the new dissolving stent will have to meet certain criteria. Leesar suggests patients talk with their cardiologists to see if they meet those criteria, and to learn more about the Absorb stent and its capabilities.
Source: UAB News