Arteriovenous (AV) Fistula for Hemodialysis

Arteriovenous (AV) Fistula for hemodialysis is a surgical connection which is made between a vein and an artery, typically in your hand as preparation for dialysis.

About the Surgery

(AV) Fistula. After a connection is made, the blood flows from the artery into the veins, resulting in enlarged veins. These enlarged veins can deliver the amount of blood flow that is necessary for successful hemodialysis treatment.

Once the surgeon is sure your blood vessels can support a fistula and you are physically fit for AV Fistula creation, an appointment will be scheduled.

    Once AV Fistula is created, it may take weeks or months for the fistula to mature to a point where it can be used for hemodialysis treatment.

    Your doctor may prescribe painkillers to help manage the pain.

Dialysis access steal syndrome and ischemic monomelic neuropathy

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FAQs and Related Articles

Before going into dialysis, your surgeon will connect artery with vein. The connection will help the blood to flow to and from dialysis machine. This blood vessel is called AV Fistula.
Before going into dialysis, your surgeon will connect the artery with a vein. The connection will help the blood to flow to and from the dialysis machine. This blood vessel is called AV Fistula.
Complications of AV FIstula are lymphedema, aneurysm, infection, stenosis, steal syndrome, congestive heart failure and thrombosis among others.
An AV Fistula is usually an connection between artery and vein in the hand. This connection can rupture if there is high pressure on it.
AV fistula surgery can take around 30 minutes

There are two types: Temporary and Permanent. Temporary catheters are inserted using a local anaesthetic to penetrate and enter into the venous system. Whereas, the permanent catheters require minor surgery in which the surgeon uses fluoroscopy to penetrate the skin and tunnel under it for a few inches before entering the venous system. Tunnelling helps to reduce the risk of infection.

The most common complication of prolonged use of catheters is infection.

Another potential risk is permanent damage to the main vessels in the chest which can lead to narrowing of the veins and clot formation(thrombosis). Access may no longer be useful. Hence physicians avoid prolonged use of catheters in dialysis.

AV Fistulas are preferred by physicians over catheters because catheters can cause serious infections and scar tissue formation due to their prolonged use.

It can lead to swelling of the arms, neck and face along with other symptoms. Scar tissue can also make access unusable for future use.

Long-term hemodialysis access requires an arteriovenous (AV) fistula which is a shunt surgically placed i.e., an artery is directly sutured to a vein, but every patient is not suitable for an AV fistula. 

Numerous needle sticks can damage veins creating scar tissue over time, which can make AV fistula impossible. If the veins are too small or damaged or too small, there might be clot formation. In such cases, another fistula at another site, an AV graft or catheter is advised.

Sometimes there may be clot formation in your access or signs of infection associated with it.

The doctor may prescribe antibiotics to combat infections, but you will have to visit the hospital for clot-related treatment.

Stenosis-narrowing of blood vessels is the most common problem. It leads to inadequate blood flow through the fistula or graft. Clotting is another common complication seen causing reduced blood flow. 

The dialysis care team will ensure that the access is working well, as it can reduce the amount of dialysis you receive by checking the fistula or graft each day or as directed by the physician. Some precautions you can follow to ensure the dialysis treatment is fine are:

Keep a tab on the blood flow several times, each day by feeling for a vibration, also called a thrill/pulse. If it is absent, or there is a change, report it to the doctor or the dialysis centre immediately.

  • Avoid wearing tight clothes or jewellery on your access arm.

  • Avoid carrying heavy items that could add pressure on the access.

  • Avoid drawing blood from your access arm.

  • Avoid sleeping with your head on the arm that has your access.

  • Avoid using a blood pressure cuff on your access arm.

  • Apply only gentle pressure to the access site after the needle is removed, too much pressure can stop blood flow completely.

  • If you notice any bleeding after dialysis, apply gentle pressure to the needle site with a clean towel or gauze and if it does not stop in 30 minutes, call your doctor or your dialysis center immediately.

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