AV (Arteriovenous) fistula creation is recognised as the preferred vascular access method for permanent dialysis. This creation involves the surgeon joining a vein directly to an artery in your arm in the wrist in your non dominant arm if the vessels are suitable. If created at the wrist it is known as a radio cephalic fistula, as the radial artery is joined or anastomosed to the cephalic vein, if sited above the elbow it is known as a brachiocephalic fistula as the brachial artery is joined/anastomosed to the cephalic vein. If you have no suitable veins or poor quality veins then prosthetic AV (arteriovenous) grafts can be used to make the join for the fistula creation.
Benefits of AVF
- There are lower infection rates because there is no foreign material, unlike a catheter inserted for dialysis which can enable a direct route for infection to enter the body.
- Higher blood flow rates for optimal dialysis sessions
- Lower rates of the incidence of thrombosis or clot formation.
- A development of a narrowing or stenosis of the fistula which is effecting your dialysis may require another procedure called a fistulogram or another operation
- Steal syndrome; where the fistula causes to much blood to go from the artery into the vein and not down into your hand. This can cause pain or a cold sensation in your hand and may also affect nerves and muscles. Another operation to reduce the blood flow may be involved.
- Risk of developing an aneurysm or ballooning in the fistula from repeated insertion of the needles from long term dialysis.
- Risk of thrombosis or clot formation; this can happen at any time but is most common in the first 24 hours post the fistula creation.
Post Procedure Precautions
- The fistula is created by your surgeon in hospital and you will go home the same day but please arrange someone to stay overnight with you.
- You should not drive or operate machinery for the first 24hrs after your surgery.
- You should avoid heavy lifting or carrying heavy shopping bags, until you have regained feeling and full movement of you arm.
- Once created you should be able to feel a vibration in your arm at the fistula site which is called a thrill. If you do not feel this contact your doctor as soon as possible.