Name of the Procedure:

Dialysis Circuit Permanent Vascular Embolization or Occlusion, Endovascular (including main circuit or any accessory veins, endovascular, with imaging and radiological supervision)

Summary

This procedure involves blocking (embolizing or occluding) blood vessels in a dialysis circuit permanently using endovascular techniques. It includes the use of imaging to guide and monitor the procedure.

Purpose

This procedure is used to address problems in the dialysis circuit, such as blockages or abnormal blood flow. The goal is to restore or maintain proper blood flow for dialysis, preventing complications and ensuring the efficiency of the dialysis process.

Indications

• Dysfunctional dialysis circuit
• Vascular access issues
• Pseudoaneurysms
• Severe bleeding in the circuit
• Stenosis or blockage of dialysis access veins

Preparation

• Fasting for at least 6 hours prior to the procedure.
• Medication adjustments as advised by your healthcare provider.
• Pre-procedural imaging, such as ultrasound or angiography, to assess the vascular access.
• Blood tests to check kidney function and clotting status.

Procedure Description

1. The procedure is usually performed under local anesthesia with sedation.
2. A small incision is made, and a catheter is inserted into the blood vessel.
3. Using imaging guidance, the catheter is advanced to the location of the target vessel.
4. Embolic agents such as coils, particles, or glue are introduced to permanently block the vessel.
5. Continuous imaging ensures proper placement and effectiveness of the embolization.
6. Upon completion, the catheter is removed and the incision is closed.

Duration

Typically takes between 1 to 3 hours, depending on the complexity of the case.

Setting

Performed in a hospital's interventional radiology suite or a specialized outpatient center.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Radiologic Technologist
• Nursing staff
• Anesthesiologist or Nurse Anesthetist

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Non-target embolization leading to unintended blockages
• Vascular injury
• Allergic reaction to contrast material
• Post-embolization syndrome (pain, fever, inflammation)

Benefits

• Improved blood flow through the dialysis circuit
• Prevention of future complications associated with poor dialysis access
• Enhanced efficiency and effectiveness of the dialysis sessions
• Immediate vascular access restoration

Recovery

• Observation in a recovery area for a few hours post-procedure
• Pain management with prescribed medications
• Instructions to keep the incision site clean and dry
• Avoid strenuous activities for a few days
• Follow-up appointments to monitor the success of the procedure

Alternatives

• Surgical revision or creation of a new dialysis access site
• Angioplasty (balloon procedure) to open a narrowed vessel
• Bypass grafting
• Conservative management with medication and observation

Patient Experience

Patients may feel a pinch at the incision site, followed by pressure as tools are inserted and manipulated. Sedation helps keep the patient comfortable. Post-procedure, patients may experience mild discomfort or bruising at the incision site, managed with pain relief measures.