Why dialysis access fails
An AV fistula or graft is the lifeline for patients on haemodialysis. Over time, the vein can narrow (stenosis), usually near the joint between artery and vein or in the veins draining the arm. Narrowing reduces flow and can lead to the fistula clotting completely.
Signs your fistula needs attention
- The thrill (buzz) feels weaker, or turns into a pulse
- Low flow or high pressures reported during dialysis
- Prolonged bleeding after needles are removed
- Arm or face swelling
- No thrill at all, which suggests a clot and needs urgent review
Treatment
- Fistuloplasty: a balloon is passed through a small puncture and inflated across the narrowing to widen it.
- Declotting (thrombectomy): removes clot from a blocked fistula or graft, ideally within 24 to 48 hours.
- Central vein angioplasty or stenting: for narrowed veins in the chest that cause arm swelling.
These are usually day-care procedures under local anaesthesia, and dialysis can often continue through the same access.
Frequently asked questions
Can a clotted fistula be saved?
Often yes, especially if treated early. Contact your doctor the same day you notice the thrill has gone.
Will I need repeat procedures?
Narrowing can recur, so some patients need angioplasty again after months or years. Regular monitoring helps catch it early.
This page is for general education and is not a substitute for medical advice. Treatment depends on your examination and test results.