If you have been diagnosed with ESRD and require dialysis, you will need to have a dialysis access placed. An AV fistula is the type of dialysis access that is considered the best choice because it generally lasts longer and has fewer problems.
What is an AV fistula?
An AV fistula is a surgical connection made between an artery and a vein, created by a vascular specialist. An AV fistula is typically located in your arm, however, if necessary it can be placed in the leg. With an AV fistula, blood flows from the artery directly into the vein, increasing the blood pressure and amount of blood flow through the vein. The increased flow and pressure causes the veins to enlarge. The enlarged veins will be capable of delivering the amount of blood flow necessary to provide an adequate hemodialysis treatment. AV fistulas are the preferred vascular access for long-term dialysis because they last longer than any other dialysis access types, are less prone to infection and clotting, and can be relied upon for predictable performance.
Advantages of an AV fistula
- Remains functional longer than other forms of vascular access
- No synthetic material implanted in your body
- Provides the necessary blood flow needed for effective dialysis, which may help to decrease treatment time
- Low risk of infection
- Less prone to clotting than other dialysis access options
- Created in an outpatient procedure under local anesthesia
- Fast return to your daily activities
How is an AV fistula created?
The first step in AV fistula creation is to evaluate your blood vessels (veins and arteries), to ensure they are healthy enough to support a fistula. The first step in the evaluation will be a physical examination of your arms performed by your vascular specialist. The next step will involve the use of non-invasive or minimally invasive tests such as ultrasound, and possibly an angiogram to determine the size and depth of your arteries and veins. These tests will determine whether or not your blood vessels are able to support an AV fistula. These tests are often referred to as “vessel mapping.” Once it has been determined that you are a candidate for an AV fistula, an appointment will be scheduled for the AV fistula creation.
To create an AV fistula, the vascular specialist will administer local anesthesia to the chosen access site. Next, your physician will make a small incision, allowing access to the selected arteries and veins. A surgical connection is made between an artery and a vein. This connection causes blood to flow from the artery into the vein, this increased blood flow through the vein results in enlargement of the vein and thickening of the vein walls. After the AV fistula has been created, it will take several weeks, in some cases a month or longer, for the fistula to mature to the point where it will be able to be used for your hemodialysis treatments.
Recovering from AV fistula creation
AV fistula creation can be done as an outpatient procedure and does not require an overnight hospitalization. In general, you should be able to go home a few hours after the procedure is completed.
You will be instructed to keep your access arm elevated to reduce swelling and pain at the access site. Your physician may also prescribe a painkiller to help manage any post-operative pain.
Before you are sent home, you will be given specific instructions on how to care for your access.
How we can help you
The interventional specialists and vascular surgeons at Azura are highly skilled in dialysis access creation and management. We can perform the AV fistula creation in our centers and help you manage your fistula when needed while you are on dialysis. At Azura Vascular Care, we work every day to deliver far more than our patients expect by bringing our full range of medical capabilities and service excellence to every patient, every visit at each of our centers nationwide.
If you would like to learn more about a specific medical condition leading to dialysis, or about dialysis itself, Fresenius Kidney Care is a complete resource for CKD.
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