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Fistulagram and Fistulaplasty

I spent a chunk of time yesterday at the hospital for my fistulagram. I got there at 9:10 for my 9:15 lab appt, and they took me back at 9:50. We then wasted some time in the coffee shop (I was NPO, so I watched Jackie drink her coffee), and then went to Radiology. Not a long wait to check in, and I was taken back to the initial area to get my history, vital signs and IV done. I then went to the IR (Interventional Radiology) Suite, and they prepped me. This involved a c/r (cardio respiratory) monitor, pulse ox, automatic bp cuff, and then prepping the arm. Dr. P came in, and started up. There was a bank of 4 monitors, some of which had the live fluoroscopy images of my arm and chest, so I was able to watch the whole procedure, and stayed awake throughout despite 150 mcg of IV Fentanyl.

It turned out that I had several areas of stenosis the length of my fistula up into my chest. After doing the initial images, he threaded a guide wire into the fistula and then inserted a catheter. For the next several hours, he inflated the balloon along the problem areas to widen it in the areas of stenosis (balloon angioplasty), and then placed a stent in a portion of the fistula (I think farther up past my arm). All in all, the actual procedure took close to 3 hours. He did say that he was surprised that I hadn’t had this before, as they like to have a fistulogram at regular intervals to avoid these problems to this extent.

It wasn’t extremely painful, just uncomfortable. It was a very strange feeling each time he inflated the balloon, and my shoulder felt like someone hit me with a hardball. The nurse told me ahead of time that the doctor tends to forget about asking about the pain while he is concentrating on the procedure (understandably so, since his main concern is the procedure itself), and that I should not hesitate to tell her when I had pain. So, everytime I asked, she gave me another hit of Fentanyl (of course, after Dr P gave his approval). He ordered it in 25 mcg doses, which I could hardly even tell were given, but the one time he ordered 50 mcg, and I got relief from that.

Next week, I’ll have pics of the fluoroscopic images. He told me to stop in on Tuesday and he’ll put them on my USB drive.

I was very impressed with both Dr. P and his staff. They made me feel very comfortable, and were truly concerned about me.

I have to go back in 2-1/2 weeks for a re-do, and will probably have to go back at regular intervals for a couple of visits. Ultimately, he said they will probably have to do surgery to insert a graft inside my fistula/vein to allow the areas of aneursym to go down, and prevent any further weakening of the vessel wall.

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