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Treating AV Fistula and AV Graft – Angioplasty and Thrombolysis in Zurich

For people who need hemodialysis three times a week, the AV fistula (arteriovenous fistula) is not a medical footnote — it is literally life-sustaining. When a fistula narrows or clots, the next dialysis session is at stake. Interventional radiology can help quickly and precisely in these situations.

When Does an AV Fistula Need Treatment?

Over time, the AV fistula or AV graft can develop narrowings (stenoses) that reduce blood flow and impair dialysis efficiency. Signs include:

  • Prolonged bleeding time after needle puncture
  • Changed sounds or thrill (vibration) over the fistula
  • Declining dialysis values (urea, creatinine clearance)
  • Arm swelling (stenosis of the outflow vein system)

Treatment Options

Balloon angioplasty (PTA)

Gold standard for fistula stenoses. A balloon is advanced via catheter to the narrowing and inflated.

Stent implantation

For recurrent or very resistant stenoses.

Catheter-directed thrombolysis / mechanical thrombectomy

For acute occlusions, the clot can be dissolved with medication or mechanically removed — often within hours.

We are available to dialysis centers and patients on short notice. After the consultation, you will receive a patient information sheet.

FAQ — AV Fistula / AV Graft

Typical signs include: worsening dialysis values (urea, Kt/V), prolonged bleeding after needle removal, changed or absent thrill over the fistula (normally you feel a vibration), and arm swelling. If you notice any of these signs, please contact your dialysis center or us directly.

No — fistula treatment is usually outpatient. The procedure takes 30–90 minutes, followed by a brief monitoring period.

Often yes – especially when the thrombosis is detected and treated early. The longer it persists, the more difficult reopening becomes. Early intervention is crucial.

After fistula stenosis or thrombosis treatment, mild tenderness at the puncture site and mild arm swelling for 1–2 days are normal.

Please contact us or your dialysis center immediately if you experience:

⚠ Absent thrill (vibration) over the fistula — this means the fistula may have re-occluded. Report immediately, as fistulas can often be saved with prompt intervention

⚠ Significant swelling of the entire arm (possible outflow obstruction)

⚠ Fever above 38.5°C (101.3°F) combined with redness at the fistula (possible infection)

⚠ Heavy bleeding at the puncture site after dialysis

Scientific References
  • Lok CE et al. KDOQI Clinical Practice Guidelines for Vascular Access (2019 update). Am J Kidney Dis. 2020;75(4 Suppl 2):S1–S164.
  • Vascular Access Work Group. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access. Am J Kidney Dis. 2006.
  • Dariushnia SR et al. Quality improvement guidelines for tunneled hemodialysis catheters. J Vasc Interv Radiol. 2016.

Would you like to know if this procedure
is right for you?

We offer personalized, discreet, and no-obligation consultations. Schedule your consultation today.

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info@irz.ch