Service · Procedural

Access problems, solved same-day.

Fistuloplasty, declotting, catheter exchange, central venoplasty — the procedures that keep dialysis access alive. In-house. No outside referrals.

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What it is

Why most dialysis problems are access problems.

Ask any nephrologist what causes the most ICU admissions, missed sessions, and bad outcomes in dialysis patients. The answer isn't the dialysis. It's the access — fistulas that fail, catheters that block, veins that scar shut.

Interventional nephrology is the discipline of fixing all of that with minimally-invasive procedures: balloons, wires, sheaths, and catheters — instead of surgery. It is what keeps a fistula alive for ten years instead of two.

Most dialysis networks in India don't have it in-house. When a fistula fails, the patient is sent across town for a procedure that won't happen for days. By then, they've had a catheter put in and lost the access. We refuse to operate that way.

"A network without interventional nephrology is a network that watches access die. We won't be that network."

How we do it differently

Salvage, not surgery.

Most access problems can be fixed through a needle stick — if the team is fast and skilled.

Fistuloplasty

Balloon-open a narrowing

When a fistula starts failing because of stenosis, we open it with a balloon — not a scalpel. Same-day, local anaesthesia, back to dialysis next session.

Declotting

Restore a thrombosed fistula

A blocked fistula can often be reopened with mechanical and pharmacological declotting — if caught within 48–72 hours. Speed is everything.

Catheter exchange

New line over a wire

When a tunnelled catheter blocks or starts to fail, we exchange it over a guidewire. Same day. Same exit site. No second tunnel needed.

Central venoplasty

Open scarred central veins

Long-term catheter use can scar central veins shut. We open them with balloon angioplasty, salvaging arms that would otherwise be unusable for access.

What to expect

From access failure to access fix.

Most procedures are done within 24 hours of the problem being identified.

Identification

Nephrologist or dialysis nurse notices a problem: weak thrill, prolonged bleeding, high venous pressures, low flow. Same-day evaluation.

Imaging & plan

Doppler ultrasound or fistulogram identifies the narrowing, clot, or blockage. Procedure planned by the same interventionist.

Procedure

Day-care, local anaesthesia, typically 30–90 minutes. Balloon, wire, sheath, sometimes stent. You go home the same day.

Back to dialysis

Most patients dialyse the next session through the same access. Follow-up imaging at 4–6 weeks confirms patency.

Frequently asked

Questions worth asking.

Before you start a treatment anywhere — these are the questions to ask. We've answered ours.

How do I know my fistula is failing?

Clues: weak or absent thrill, prolonged bleeding after dialysis, low flow rates, rising venous pressures, swelling of the arm. Any of these need same-day review.

Is fistuloplasty better than re-doing surgery?

Almost always, yes. Fistuloplasty preserves the original fistula. New surgery means new healing, new maturation time, often a catheter in between. We start with the balloon and operate only when we have to.

Are these procedures painful?

They are done under local anaesthesia, sometimes with mild sedation. Most patients describe pressure and mild discomfort, not pain. You're awake throughout and home the same day.

How often will I need procedures on my fistula?

Varies wildly. A well-mapped, well-cared-for fistula may never need intervention. A complex one may need maintenance fistuloplasty every 6–12 months. Surveillance is the secret — we catch problems before they become emergencies.

Talk to a nephrologist.

Whether you're starting dialysis, switching centres, or just want a second opinion — one conversation tells you everything you need.

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