AV Fistula


What is an AV fistula?

When your kidney function consistently declines, you and your physician are concerned about impending kidney failure, and dialysis is fast becoming your only option, you’ll need to discuss an dialysis access with your physician and with us, your vascular surgeons. 

With a minor surgical procedure, our vascular surgeons can create an arteriovenous fistula to provide access for the equipment which removes wastes and fluid from your blood. The fistula increases the blood flow and strengthens the vein to allow an even greater flow, making dialysis efficient and effective.

Time is a significant deciding factor in the choice of access that will be created, along with the size and health of your veins. When you have about 6 months before you expect dialysis to begin, an AV fistula may be your best choice.

An AV (artery-vein) fistula is created from your own tissues, joining an artery to a vein. Your surgeon will connect a vein to a nearby artery, creating a larger, stronger blood vessel with a robust, fast blood flow, usually in the wrist or elbow of your non-dominant arm. An AV fistula provides excellent blood flow when mature. You will be able to take showers once your surgery heals.

For best maturation and functioning, your fistula surgery should take place about 6 months before you begin dialysis. A fistula can take 4 weeks to 4 months to mature before it can be used. Your dialysis technician will use needles to connect your blood vessels to the filtering machine. 

After surgery, you will be encouraged to strengthen your veins by squeezing a stress ball. Proper care of your access is vital to its long term health. Complications can include:

  • “steal”, when the fistula causes too much blood to flow away from your hand
  • clotting
  • infection
  • narrowing
  • bleeding
  • formation of an aneurysm in the access

Fistulas are preferred whenever possible as they tend to be more durable, lasting for years. They are also less inclined to infection and complications like clotting.

Wash your access site each day with an antibacterial soap and pat dry. Do not scratch or rub near your access site. Do not have your blood pressure measured on your arm with your access, or have blood taken from that arm. Check the flow of your blood, called a thrill or bruit, daily and call us if it seems different or you cannot find it. 

While your access matures, and for as long as you continue dialysis, our doctors will care for and monitor the function of this access. If at any time your access bleeds, or is red, painful, swollen, warm or cold, call our office immediately. Call our office if you feel short of breath, experience chills or aches or have a temperature. When your access arm tingles, feels cold or weak or if your fingertips are blue or sore, call us immediately.

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