Fistula Creation Overview
In the case of an ESRD diagnosis requiring dialysis, the establishment of a dialysis access becomes necessary. The preferred choice is an AV fistula, known for its longer lifespan and fewer complications.
An AV fistula is a surgical connection crafted by a vascular specialist between an artery and a vein. Typically located in the arm, it can be placed in the leg if required. This connection allows blood to flow directly from the artery into the vein, elevating blood pressure and increasing blood flow through the vein. The resulting enlargement of veins ensures a sufficient blood flow for effective hemodialysis treatment. AV fistulas stand out as the preferred vascular access for long-term dialysis due to their extended durability, lower susceptibility to infection and clotting, and consistent, predictable performance.
Advantages of an AV fistula
- Boasts a longer functional lifespan compared to alternative vascular access methods
- Excludes the use of synthetic materials implanted in the body
- Ensures essential blood flow for efficient dialysis, potentially reducing treatment duration
- Minimal risk of infection
- Demonstrates lower susceptibility to clotting compared to other dialysis access alternatives
- Established through an outpatient procedure under local anesthesia
- Swift return to daily activities
How is an AV fistula created?
The initial step in the creation of an AV fistula involves assessing the health of your blood vessels, including veins and arteries, to ensure they can adequately support a fistula. This evaluation commences with a physical examination of your arms conducted by a vascular specialist. Subsequent steps encompass non-invasive or minimally invasive tests, such as ultrasound and potentially an angiogram, to determine the size and depth of your arteries and veins. These tests, often termed “vessel mapping,” ascertain the suitability of your blood vessels to support an AV fistula. Once it is confirmed that you are a suitable candidate, an appointment for AV fistula creation will be scheduled.
During the AV fistula creation procedure, the vascular specialist administers local anesthesia to the selected access site. Following this, a small incision is made, providing access to the chosen arteries and veins. A surgical connection is established between an artery and a vein, causing blood to flow from the artery into the vein. This increased blood flow leads to vein enlargement and thickening of the vein walls. After the AV fistula is created, it takes several weeks, and in some cases a month or longer, for the fistula to mature sufficiently to be utilized for hemodialysis treatments.
Recovering from AV fistula creation
Creating an AV fistula can be carried out as an outpatient procedure, eliminating the need for an overnight hospital stay. Typically, you should be able to return home a few hours after the completion of the procedure.
Following the procedure, you will receive guidance to keep your access arm elevated, which aids in reducing swelling and alleviating pain at the access site. Additionally, your physician may prescribe a painkiller to help manage any post-operative discomfort.
Before your discharge, you will be provided with specific instructions on how to care for your access.