AV Fistula for Dialysis: Surgery, Care and Complications

If your kidneys are failing and you need dialysis, the doctor may speak about an AV fistula. It is the preferred way to reach the blood for haemodialysis, because it lasts longer and has fewer infections than other options. It needs to be made weeks ahead, so early planning matters.

What is an AV fistula?

AV stands for arteriovenous. In this minor operation, a surgeon joins an artery to a vein, usually in the arm. The extra blood flow makes the vein thick and strong, so it can take two dialysis needles again and again. It is not the same as an anal fistula, which is a different problem.

Why is it preferred?

• It lasts longer, often for years

• Lower risk of infection than a catheter in the neck or chest

• Better blood flow, so dialysis works more effectively

• Fewer hospital visits for blocked lines

Before the surgery

• The surgeon examines your arms and does an ultrasound to map the vessels

• Usually the non-dominant arm is used first (the left arm, if you are right-handed)

• If you have kidney disease, protect your arm veins early. Avoid blood tests and drips in the arm that may be used.

• Blood tests and a fitness check are done

How the operation is done

The surgery is done by a vascular surgeon, usually under local or regional anaesthesia. It takes about 1 to 2 hours. A small cut is made near the wrist or elbow, and the artery and vein are joined. Most people go home the same day.

• At the wrist: radiocephalic fistula, usually the first choice

• At the elbow: brachiocephalic fistula, used if the wrist vessels are small

• If your own veins aren't suitable, a graft (a soft tube) may be used

Maturation: when can it be used?

A fistula takes time to mature. It is usually ready in 6 to 12 weeks, sometimes longer. A mature fistula feels like a buzzing or humming thrill under the skin. If dialysis is urgent before it is ready, a temporary catheter is used.

How to care for your fistula

• Feel for the thrill every day. If you can't feel it, call your doctor the same day.

• Keep the arm clean. Wash with soap and water before dialysis.

• Don't let anyone take blood, give drips or measure blood pressure on that arm

• Don't wear tight sleeves, watches or bracelets on that arm. Don't sleep on it or carry heavy bags on it.

• After surgery, do hand and arm exercises, such as squeezing a soft ball, when your surgeon says it is safe. They help the vein grow.

• After dialysis, press the needle sites as shown and look for bleeding

• Keep the dressing clean and dry after surgery, and watch the wound

Get help now: Go to the hospital now if the fistula bleeds heavily and doesn't stop with pressure, you lose the thrill, the hand turns cold, pale or blue, or you have severe pain. The same goes for redness, pus or fever near the fistula.

Possible complications

• Infection at the wound or the needle sites

• Clotting (thrombosis), which stops blood flow and needs urgent treatment

• Narrowing of the vein (stenosis), which can be opened with a small procedure

• Failure to mature, if the vein doesn't grow enough

• Steal syndrome: too much blood goes into the fistula and the hand gets cold, numb or painful

• Swelling of the arm, or a bulge in the vein (aneurysm) from repeated needles

• Strain on the heart, rarely, if the flow is very high

Most of these can be treated if caught early. That is why daily checks and follow-up visits matter.

Common questions

Is AV fistula surgery painful? The arm is numbed during the operation. Mild soreness afterwards settles in a few days.

How long does an AV fistula last? Often for years, with good care. Some last a decade or more.

When should I get a fistula made? Ideally several months before you need dialysis. Ask your kidney doctor early.

Can I lift things with that arm? Light daily use is fine once healed. Avoid heavy lifting and pressure on the arm.

Have questions or want to see a specialist? For appointment and queries, call 8156929292. AXTEN HOSPITALS - HONEST SURGERY, HONEST CARE.