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Suggest treatment for blocked fistula

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Posted on Wed, 2 Dec 2015
Question: 1st fistula blocked after 2 months. For emergency purpose, jugular at neck is being used for dialysis since 20 days. left hand and left leg are paralyzed since 5 years. went for 2nd fistula option on upper side of left hand only but that was blocked 3 days after the surgery done. We are not sure what should be done now? is it recoverable if we approach a vascular surgeon immediately within 48 hours ? Kindly suggest us what should be the next steps?
doctor
Answered by Dr. Rakesh Madhyastha (8 hours later)
Brief Answer:
Can be recovered

Detailed Answer:
Hello

Thanks for the query

When the fistula gets blocked if the vascular surgeon is approached immediately ( not within 48 hours but as soon as possible) thrombectomy can be attempted. However re blockage of the fistula is extremely common.
In patients who have recurrent blockage of the fistula I recommend them 3 things
1. Permanent catheter, it is similar to your jugular but the catheter will come near your arm pits
2. Peritoneal dialysis ( second best option)
3. Renal transplant ( best option)

I hope I was of help, if you have any further queries please get back to me

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Rakesh Madhyastha (3 hours later)
Thanks a lot for quick response.

Permanent catheter/Peritoneal dialysis which one is best in terms of less complications and long term? Which specialist will perform these surgeries?

Appreciate your response.When I talk to urologist who created fitsula which is created 3 days back said that going for remove the blockage doesn't help much. I understand that remove the blockage on unmatured fitsula may not help as it may re block or may not mature. Is my understanding correct? Or should I consult vascular surgeon to remove the blockage.
doctor
Answered by Dr. Rakesh Madhyastha (14 hours later)
Brief Answer:
Vascular surgeon

Detailed Answer:
Hello

Thanks for getting back
Blockage is best remove by vascular surgeons, I recommend getting the next fistula by a vascular surgeon
Between peritoneal dialysis and perm XXXXXXX peritoneal dialysis is better with lesser complications if strict aseptic precaution is taken

I am sure you have several doubts. feel free to get back to me

Regards
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Rakesh Madhyastha (10 hours later)
Thanks Doctor for detailed answer. Two fitsulas are blocked/failed. Still to consider another fitsula before looking to perm cath/peritoneal. Which specialist will do perm cath/peritoneal dialysis.
doctor
Answered by Dr. Rakesh Madhyastha (21 hours later)
Brief Answer:
Nephrologist

Detailed Answer:
Hello

Thanks for your kind words. Approach a nephrologist, he will arrange for peritoneal dialysis catheter to be placed. Perm Caths are placed by nephrologists

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Rakesh Madhyastha (2 days later)
Thanks a lot for detail answers.
doctor
Answered by Dr. Rakesh Madhyastha (41 hours later)
Brief Answer:
Regards

Detailed Answer:
Hello

Thanks for the kind words. I am currently on a vacation, I'll be back on 13th. If you have any further doubts please feel free to get back to me

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4364 Questions

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Suggest treatment for blocked fistula

Brief Answer: Can be recovered Detailed Answer: Hello Thanks for the query When the fistula gets blocked if the vascular surgeon is approached immediately ( not within 48 hours but as soon as possible) thrombectomy can be attempted. However re blockage of the fistula is extremely common. In patients who have recurrent blockage of the fistula I recommend them 3 things 1. Permanent catheter, it is similar to your jugular but the catheter will come near your arm pits 2. Peritoneal dialysis ( second best option) 3. Renal transplant ( best option) I hope I was of help, if you have any further queries please get back to me Regards