Leading research at the Lister helps keep renal patients dialysing well

Preparing patients for life-saving haemodialysis involves the creation of what is called a fistula – a surgical connection between an artery and vein – usually in the forearm or upper part of the arm that then allows dialysis to take place.

Fistulas can become blocked if the vein used narrows over time, but the Lister-based team is involved in research aiming to show how the use of a minimally invasive technique using inflatable balloons can be used successfully to widen these narrow sections of vein and thus allowing a patient’s dialysis to carry on as normal. The team is looking at balloons carrying a drug that helps to prevent narrowing and targeting those veins at the greatest risk of this happening.

Kate Steiner, first left

Commenting on this research-led initiative, one of the Trust’s consultant interventional radiologists, Dr Kate Steiner, said:

“Patients with fistulas often experience a narrowing of the vein, which can lead to poorer dialysis or even the fistula blocking if a clot forms. Unless tackled quickly, this could lead to the fistula becoming unusable a new one needing to be formed. Through the use of minimally invasive techniques, which can be carried out on a day case basis, we can now insert a tiny balloon into the narrowed area, inflating it to expand the narrow section of vein, allowing the fistula to work normally again.

“We also know that in many cases, narrowing is caused by cells in one layer of the vein growing rapidly. Through using balloons carrying a drug that helps to stop cells dividing in this way, we are hoping to show that the widening of affected veins lasts for longer than just using plain balloons alone. Because the balloons carrying the drug are more expensive to use, we are also working with our histopathology team colleagues researching ways to identify those patients who would benefit them and those for whom normal balloons are the right option.

“We are one of several UK hospitals taking part in the Paclitaxel assisted balloon Angioplasty of Venous stenosis in haEmodialysis access (PAVE) study, which is a large multi-centre clinical trial funded by the National Institute for Health Research, and we are also taking part in the Lutonix Global Registry. Between them, the results of these two large studies – along with that of research being undertaken separately at the Lister – will improve our understanding of why veins in a fistula narrow and how best to treat them. In this regard, the work being undertaken by myself and my colleagues is right at the cutting edge of this area of great importance to the health and well-being of our patients.”

And here is a patient’s story on how this research has helped them.