Arteriovenous (AV) Fistula Surgery For Dialysis

Overview - AV-Fistula

Arteriovenous fistula surgery is a procedure that connects an artery to a vein for dialysis (a procedure to remove waste and toxins from the body when the kidneys are not functioning properly). The AV Fistula acts as an access point for the dialysis machine. A fistula surgery for dialysis is a good solution in the long run for treating chronic kidney diseases. AV fistulas are most commonly created on the hand. A vascular surgeon performs the AV fistula surgery as an outpatient procedure. It is done under general anesthesia; you can usually go home the same day.

What is Meant by AV Fistula Surgery?

The arteriovenous fistula is an artificial connection created for dialysis. The procedure for creating this fistula is known as AV fistula surgery for dialysis. AV fistula forms the access point for the dialysis machine. An AV fistula for dialysis is typically placed in the arm, near the elbow or wrist. With the creation of an AV fistula, blood flows into the vein from the artery. This increases the amount of blood flowing in the vein, leading to a subsequent increase in blood pressure. The veins are thus enlarged, making them capable of delivering the blood required for dialysis. After the AV fistula surgery, the veins require about 6 to 8 weeks to get wider and thicker; after this period, the fistula can be used for dialysis. This process is termed ‘maturing.’ Once the AV fistula is matured, the dialysis procedure can be commenced. Hence, dialysis with AV fistula's help must be a planned procedure. It cannot be used for emergency dialysis. 
Most surgeons prefer the AV fistula for dialysis to other access points. This is because fistula dialysis problems are seen less in AVF dialysis. AV fistula lasts longer, is less prone to infection and clotting, and has better results. 

Sometimes the surgeon may place an AV graft in the arm for dialysis. Unlike an AV fistula, an AV graft is a synthetic tube used to surgically connect the artery and the vein. The tube helps to redirect blood from the vein into the artery. An AV graft for dialysis functions in the same way as an AV fistula for dialysis.

There are three types of AV Fistula surgery for dialysis, depending on the artery and veins involved.

• Radiocephalic Fistula- This is a type of forearm fistula. The connection is made between the arm's radial artery and the cephalic vein.
• Brachiocephalic Fistula- This fistula in the arm connects the brachial artery to the cephalic vein. This fistula is located at or above elbow level.
• BTB Fistula ( Brachial artery-To-Transposed cephalic vein )- BTB fistula is considered only when a radiocephalic fistula or brachiocephalic fistula cannot be created.

When is AV Fistula Surgery Recommended?

AV fistula surgery is recommended as part of a long-term treatment plan for end-stage renal disease. End-stage renal disease is characterized by renal failure and the inability of the kidneys to filter out the toxins and waste products in the blood. This is seen in the following conditions-

• Polycystic kidney disease- an inherited condition that causes large cysts in the kidney
• Renal artery stenosis (narrowing of the renal artery causing the improper blood supply to the kidney tissues)
• Trauma to the kidneys
• Abuse of certain medications that affect the kidney irreversibly.
• Cancer of the Kidney (s)
• Repeated infections of the bladder and kidneys
• Autoimmune diseases that affect the kidneys, like lupus nephritis, where the body produces antibodies that attack the healthy cells.

How to Prepare for AV Fistula Surgery?

AV fistula surgery for dialysis is an outpatient surgery done under general or local anesthesia. Here are the pre-procedure details to help you prepare for the surgery-

• You can ask your surgeon to explain the procedure's details, the necessity of the procedure, and the benefits of getting an AV fistula. You will be asked to sign an informed consent form agreeing to proceed with the procedure.
• Discuss your medical history with your surgeon and inform him about-
  • All the medications that you are currently taking for your health conditions
  • Any dietary supplements and herbs that you are taking
  • Allergies towards medicines, if any.
• You will be asked to stop medications like blood thinners (to prevent excessive bleeding during and after the procedure) a week before the AV fistula surgery.
•  A vascular surgeon will conduct a physical evaluation of your arm. AV fistula surgery is usually performed in the non-dominant arm. You will be asked to undergo certain tests like-
  • Vessel mapping- This is an ultrasound test done to check the size and quality of your artery and vein
  • Angiography- This is a type of X-ray test that is used to check the depth of the artery and vein
  • Complete blood count- To check your overall health.
• On the day of the procedure, you will be asked to fast for at least 4 hours before the procedure.
• You will be asked to arrange for a friend or relative to drive you home after the AV fistula surgery is completed.

How is AV Fistula Surgery for dialysis Performed?

Creating an AV fistula for dialysis is a procedure that takes about 1 to 2 hours. 

• On the day of the surgery, you will be given local anesthesia on the site where the arteriovenous fistula for dialysis needs to be created. This helps to numb you to the pain. Sometimes, the surgeon will prefer local anesthesia to put you to sleep during the surgery.
• The surgeon makes a small incision that allows access to the selected arteries and veins.
• A surgical connection is made between the artery and vein. This AV fistula allows blood to flow from the artery to the vein.
• In an AV Graft, the surgeon will place a synthetic tube connecting the artery and vein.
• Once the AV fistula has been created, it will require about 6 to 8 weeks to “mature.”’. This is the process where the vein enlarges to an extent where the AV fistula dialysis becomes easy.

What to Expect after AV Fistula Surgery?

AV fistula surgery is usually done as an outpatient procedure. You can go home once the effects of anesthesia have worn off. Here is what happens after arteriovenous fistula surgery for dialysis.

• The site of the incision is prone to infection. Keep it clean and dry at all times. Call your doctor if you see any redness, swelling, or pain around the site of infection.
• Keep the operated arm elevated at all times. This helps to reduce the swelling.
• You will experience pain after the procedure. Your surgeon will prescribe medications to help you deal with the pain.
• A follow-up appointment, usually 6 weeks after the AV fistula surgery, will be scheduled. During this visit, ultrasound mapping of the fistula is done to assess the blood flow through the AV fistula. This helps to determine whether AVF dialysis can be commenced or not.
• If the fistula is malfunctioning, your surgeon may recommend an AV graft. 
• If the AV fistula surgery is successful and the fistula functions properly, the dialysis procedure can be started. 
• Once the dialysis starts, the dialysis team will monitor the AV fistula for any possible problems. Fistula dialysis problems include low blood flow through the fistula, blood clots, and infection. 
• In such cases, the surgeon will evaluate the AV fistula and may recommend getting an AV graft.

Here are some key things to keep in mind to avoid complications following a fistula surgery for dialysis-

• Do not sleep with the operated arm under your head or body.
• Avoid carrying heavy objects with the arm having the AV fistula.
• Avoid wearing tight sleeves and jewelry on the operated arm.
• Blood pressure must be measured using the other arm.
• Be careful not to injure the area with the fistula in the arm.

What are the Benefits and Risks of AV Fistula Surgery?

Arteriovenous fistula for dialysis is a procedure that greatly benefits people suffering from end-stage renal disease who need hemodialysis for survival. However, as with all procedures, AV fistula surgery also has its share of risks. You must be aware of all the risks and benefits before you sign up for this surgery.

Benefits of AV Fistula Surgery

• AV Fistulas remain functional for a longer time as compared to other methods.
• The treatment time is significantly reduced because the AV fistula provides the necessary blood flow.
• The risk of infection is low.
• The chances of blood clotting are less compared to other forms of dialysis.
• AV Fistula surgery does not involve placing synthetic material inside your body.
• It is an outpatient procedure that does not require a hospital stay.
• You can return faster to your daily activities.

Risks of AV Fistula Surgery

• Allergic reaction to anesthesia.
• Excessive bleeding.
• Infection of the site of the incision.
• Deep vein thrombosis (formation of blood clots in the veins in the legs).
• Steal Syndrome (a condition where the small blood vessels and capillaries do not get adequate blood leading to coldness and tingling in the fingers. This happens because the AV shunt pulls all the blood toward the fistula leaving less blood for the capillaries).
• Narrowing of the vein or artery.
• Failure of the AV fistula formation.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!