What is Arteriovenous Fistula Creation?
Arteriovenous (AV) fistula creation is a vascular access procedure in which a surgical connection is made between an artery and a vein by a vascular specialist for the purpose of dialysis treatment. It is a surgically created large vein that provides easy access to the bloodstream and can withstand repeated needle insertions as required in hemodialysis. The AV fistula is usually placed on the forearm or upper arm; however, it may also be placed on the leg.
Hemodialysis or dialysis is a procedure performed to manage patients suffering from kidney failure. A dialysis machine takes over the function of the diseased kidneys by filtering the blood of waste products. During dialysis, you will be attached to a machine called a dialyzer through a thin tube. Your blood is then drawn into the machine for filtration through a needle inserted in your arm. The blood is circulated in the dialyzer and the filtered blood is returned back to your body through another tube.
The creation of an AV fistula causes additional pressure and additional blood to flow into the vein, making it grow larger and stronger. The larger vein offers easy and reliable access to blood vessels. Without this type of access, regular hemodialysis sessions would not be possible. Hemodialysis is usually performed 3 times a week, so it requires easy access to the bloodstream each time.
Indications for Arteriovenous Fistula Creation
Arteriovenous fistula creation is recommended when you have been diagnosed with end-stage renal disease (ESRD)/kidney failure and require hemodialysis treatment to sustain life. An AV fistula is a type of vascular access that helps facilitate hemodialysis.
Usually, two types of vascular accesses are created for long-term use: the arteriovenous fistula and the AV graft. A third type of vascular access called the venous catheter is created for short-term use. Your physician may indicate AV fistula creation over other types of accesses for the following reasons:
- Lasts longer
- Low risk of infection
- Low risk of blood clots
- Provides better blood flow for dialysis
- No synthetic material implanted as in AV graft
- Quicker return to your daily activities
Preparation for Arteriovenous Fistula Creation
Preparation for AV fistula creation may involve the following steps:
- Venography or Doppler ultrasound tests to evaluate the condition of your blood vessels (veins and arteries) to ensure they are healthy enough to support a fistula and to determine how quickly and how much blood flows through the blood vessels in order to choose the best blood vessel for fistula creation.
- You need to inform your physician if you have allergies to certain medications, local anaesthetic, or latex.
- You should also inform your doctor of any medications or supplements you are taking or any conditions you have such as blood disorders, heart or lung disease.
- You may be asked to stop taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a specific period.
- You should not consume solids or liquids at least 6 hours prior to the procedure.
- Arrange for someone to drive you home after the procedure as you may not be fit enough to drive yourself.
- Written consent will be obtained from you after the procedure has been explained in detail.
Procedure for Arteriovenous Fistula Creation
In general, an arteriovenous fistula creation will involve the following steps:
- You will lie on your back on the procedure table and the skin over the AV fistula site, usually the arm, is cleaned with an antiseptic solution and local anaesthesia is administered to numb the area.
- Alternatively, general anaesthesia may be administered so you are asleep during the procedure. With local anaesthesia, you remain awake and may feel some pressure at the site, but no pain.
- Once you are comfortable, your physician makes a small surgical cut on the arm to gain access to the blood vessels.
- The selected artery and vein are incised and surgically connected with sutures.
- The skin incision is then closed with sutures, and a bandage is placed over the incision.
- This procedure to create an AV fistula usually takes about an hour. It requires about 2 to 3 months for the fistula to mature or develop enough before it can be used for hemodialysis.
Recovery and Post Procedure Care
AV fistula creation can be performed in an outpatient setting and most patients can expect to be discharged after a few hours in the recovery room. There may be a slight discharge for 24 hours and soreness from the incision site for a few days after surgery. You will be given medication for any postoperative pain and advised to keep the arm elevated to reduce swelling. Specific instructions will be given on how to care for the AV fistula access site. To protect the access site, you should take the following precautions:
- Wash the vascular access site every day and keep it clean and dry.
- Ensure that your doctor checks the access site before each hemodialysis treatment.
- Use the access site only for dialysis.
- Be careful not to bump or injure the access site.
- Check for the thrill (a rhythmic vibration) over the access site, which indicates the AV fistula is healthy.
- Do not put a blood pressure cuff, tight clothing, or jewellery over the access site.
- Do not lift heavy objects with the access arm.
- Avoid sleeping with the access arm under your head or body.
- Report any signs of infection such as redness, swelling, or pus drainage to your doctor as soon as possible.
Risks and Complications
Arteriovenous fistula creation is a relatively safe surgical procedure; however, as with any surgery, some risks and complications may occur, such as:
- Bruising and soreness
- Post-procedure pain
- Blood clots in the arm or leg
- Blocked or narrowed AVF
- Steal syndrome (ischemia of the hand with AVF)