What is venoplasty and how is it performed?

A venoplasty is a minimally invasive procedure that uses a balloon to stretch out narrow central veins (typically in the chest or pelvis) using air pressure. The small balloon is inserted and hereafter inflated in order to stretch this narrowing. The balloon is then easily and quickly deflated and removed. During the procedure, the patient's skin (over the fistula) will be cleaned thoroughly followed by sterile drapes being placed in and around the area surrounding the fistula to allow for local anaesthetic to be injected. 

The next step in the routine procedure involves an extremely small tube then being inserted directly into the patient's fistula. The doctor performing the procedure is helped and guided by small guidewires, which are directly passed through this small inserted tube. These guidewires then pass over the narrow piece of vein. 

At this stage in proceedings, the small balloon is placed over one of the guidewires and is inflated to the appropriate size, depending entirely on the size of the given narrowed vein. The inflated balloon then stretches out the narrowed vein, and is stretched out as far as the overall size of the balloon. The stretching out of the vein typically lasts between 30 seconds and a minute and can be quite painful, so conscious sedation is offered to the patient if required. 

Interventional radiologists are responsible for performing this procedure. 

Why might one require a venoplasty?

A venoplasty procedure becomes necessary when individuals experience an impediment to the natural flow of blood within their veins, typically resulting from the constriction or narrowing of a blood vessel, medically known as stenosis. This narrowing phenomenon can, at times, be attributed to the intricate network of blood vessels comprising a fistula, leading directly to the vexing issue of vein constriction. The ramifications of such narrowing can manifest as problems like arm swelling or bleeding, which, if left unattended, can jeopardise the functionality of the fistula - an essential conduit for effective dialysis. In light of this, it becomes imperative to promptly address this issue to avert potential complications such as clot formation or the failure of the fistula.

What are the main risks involved?

While a venoplasty procedure is generally considered a safe and low-risk intervention, it is vital for patients to have a comprehensive understanding of the potential risks associated with it before making an informed decision. The primary risks associated with a venoplasty procedure encompass the following:

Rupture of the vein: There is a minute risk of the vein experiencing a rupture during the procedure, although such instances are exceedingly rare.

Bleeding: Patients should be aware of the possibility of post-procedural bleeding, although this risk is usually mitigated by the expertise of the medical team.

Bruising: Minor bruising may occur at the venoplasty site, which is typically a transient and self-limiting side effect.

Perforation: In some cases, a small hole may inadvertently develop in the vein during the procedure.

Medical professionals are well-equipped to manage such occurrences promptly and effectively.

What happens after a venoplasty?

Following a venoplasty procedure, the patient's well-being is closely monitored for a duration of two hours. If the patient exhibits no signs of discomfort or adverse reactions during this observation period, they are generally allowed to return home on the same day as the procedure. On occasion, a follow-up ultrasound examination may be recommended approximately six weeks after the initial venoplasty to assess the long-term effectiveness of the intervention. Crucially, all patients preparing for a venoplasty must arrange for a family member or friend to collect them from the hospital after the procedure. Furthermore, it is advisable for the patient to have a companion stay overnight with them following the venoplasty, ensuring a supportive and safe recovery environment. This precautionary measure adds an extra layer of assurance to the patient's post-procedure care, promoting optimal healing and peace of mind.

What to watch out for following a venoplasty

Patients who have undergone a venoplasty procedure should go straight to their nearest Accident and Emergency Department if they notice or experience severe pain, fever, a substantial amount of bruising or swelling, and/or any bleeding from the area where the procedure was performed.