What is the role of fistulography in the evaluation of fistula-in-ano (anal fistula)

A fistulogram is a special x-ray procedure. It uses contrast (x-ray dye) to look at the blood flow in your fistula or graft (dialysis access). This procedure can check to see if it is blocked or if there is any narrowing (stenosis) and a fistulogram uses a form of real-time x-ray called fluoroscopy and a barium-based contrast material to produce images of an abnormal passage within the body called a fistula. Similarly, a sinogram assesses an abnormal passage called a sinus that originates or ends in one opening, often on the skin. Both examinations are used to assess and diagnose the size and shape of fistulas and sinuses and any related abscess and/or infection.You will be instructed on how to prepare. You may be asked to refrain from eating or drinking anything for several hours before the examination, but you should be allowed to take medications with small amounts of clear fluid up to two hours prior. Tell your doctor if there's a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you're taking and allergies, especially to contrast materials. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

Fistulography may be warranted in patients with recurrent fistulas or when a prior procedure has failed to identify the internal opening. With this technique, the external opening is cannulated with a small-caliber tube and contrast material is injected under minimal pressure while films are taken in several projections. Fistulography may be useful in identifying unsuspected pathology, planning surgical management, and demonstrating anatomic relationships.

iranian surgeryHow do I prepare for my procedure?

  • Get your blood tests done 7 days before your procedure date. The doctor who scheduled you for the procedure will give you a requisition (an order form) for these blood tests.
  • Tell your vascular access coordinator if you are taking any anticoagulants (also called blood thinners) such as Aspirin, Plavix, Coumadin (Warfarin). They will check with your kidney specialist to see if you need to stop your medicine and if it's safe for you to stop these medicines before your procedure.
  • You must have someone take you home after your procedure, or your procedure will be cancelled. You can’t go home by yourself, even in a taxi or Wheel Trans.
  • Bring all of your medicines and a list of all of your medicines with you to your procedure.

What can I expect?

  1. We bring you into the procedure room and ask you to lie on a table with machines all around you. We connect you to a monitor that shows your blood pressure, heart rate and oxygen level.
  2. The nurses may give you oxygen and medicine to help you relax.
  3. We cover you with sterile (clean) drapes from your shoulders to your feet.
  4. The doctor places your fistula or graft arm out on a small table and cleans your skin. It may feel cold and wet.
  5. The doctor injects some medicine to numb the area they will check on your fistula or graft.
  6. Once your skin is numb, your doctor places a tiny catheter (tube) in your fistula or graft. This tube is similar to the needle used during dialysis. The doctor then injects contrast dye into the tube, so they can see what is happening to your fistula or graft on x-rays.
  7. If your fistula or graft has stopped working, your doctor may inject blood thinners into the tube.
  8. If they find a narrowing, your doctor puts a thin wire with a balloon at the end of it into the tube. When the balloon is inflated, it stretches the narrowing. You may feel some pressure when this happens. Your nurse can give you more pain medicine or sedatives, if you need it.
  9. When the procedure is done, your doctor removes the tube. Your doctor or a nurse will press on the puncture site (place where the tube went in) until any bleeding stops. You may get 1 or 2 stitches at the puncture site. In some cases, you go to the recovery area with the tube and stitches, and we remove the tube before you go home.

What can I expect after?

  • We take you to the Medical Imaging Day Unit to recover. You stay for about 1 to 2 hours.
  • During this time, your nurse checks to see how you are doing. They also check your fistula or graft area for any bleeding.
  • When you are ready, you can go home or to the Dialysis Unit. The vascular access coordinator will let you know where to go. • You must have someone pick you up and take you home or to your dialysis treatment.

10 common question about fistulography

1What is a Fistulogram procedure?
A fistulogram is a special x-ray procedure. It uses contrast (x-ray dye) to look at the blood flow in your fistula or graft (dialysis access). This procedure can check to see if it is blocked or if there is any narrowing (stenosis).
2Is a Fistulogram painful?
You may feel a warm sensation as the contrast material is injected into your fistula/sinus. While you may experience discomfort during the procedure, there is usually no pain.
3What is a Fistulagram?
A fistulagram is an X-ray procedure to look at the blood flow and check for blood clots or other blockages in your fistula.
4How serious is a fistula?
A fistula may cause complications. In some cases, fistulas might not heal and become chronic. Other potential complications include fistula drainage, sepsis, and perforation and peritonitis. Sepsis is a life-threatening illness that results from the body's response to a bacterial infection.
5How long does a Fistulagram take?
one to two hours During Your Procedure The interventional radiologist will insert a needle into your fistula, contrast will be injected and several x-ray images will be taken. A fistulagram usually takes one to two hours to complete.
6What is a Fistulogram with angioplasty?
An angiogram/fistulogram is an x-ray used to look inside your dialysis access. It's done to look for any narrowing or blockage in the access. Dye may be used in this procedure.
7What is a fluoroscopic exam?
Fluoroscopy is a study of moving body structures. It's much like an X-ray "movie" and is often done while a contrast dye moves through the part of the body being examined. A continuous X-ray beam is passed through the body part and sent to a video monitor so that the body part and its motion can be seen in detail.
8What is a dialysis fistula?
A surgeon connects an artery to a vein, usually in your arm, to create an AV fistula. An artery is a blood vessel that carries blood away from your heart. ... The AV fistula is a blood vessel made wider and stronger by a surgeon to handle the needles that allow blood to flow out to and return from a dialysis machine.
9How is an angioplasty performed?
It is done by threading a catheter (thin tube) through a small puncture in a leg or arm artery to the heart. The blocked artery is opened by inflating a tiny balloon in it. With coronary angioplasty, a thin, expandable balloon is inserted into the clogged artery and is inflated.
10What is a graft for dialysis?
Graft placement for hemodialysis If your veins are too small for a fistula or your veins are blocked, your doctor may suggest an arteriovenous (AV) graft. A graft is a man-made tube that is inserted into your arm to connect an artery to a vein. Grafts can usually be used for dialysis within two to six weeks.


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