Vascular Condition
AV Fistula Surgery
An arteriovenous (AV) fistula is a surgically created connection between an artery and a vein, most commonly in the forearm or upper arm. It is the preferred form of permanent vascular access for patients requiring regular haemodialysis. A well-functioning AV fistula provides reliable, long-lasting dialysis access with fewer complications than other access types.
Symptoms
- This is a planned surgical procedure rather than a condition with symptoms
- Patients referred are those with chronic kidney disease approaching or on dialysis
- Problems with an existing fistula include reduced flow, swelling of the arm, or failure to mature
Causes & Risk Factors
- Chronic kidney disease requiring haemodialysis
- Fistula failure or inadequate maturation
- Thrombosis or stenosis of a previous access site
Treatment
AV fistula creation is performed as a day procedure under local anaesthesia. The most common site is the wrist (radiocephalic fistula) or elbow (brachiocephalic fistula). Fistula maturation takes six to eight weeks before it is ready for dialysis use. Dr. Abraham also manages fistula complications including stenosis and thrombosis.
Recovery & Aftercare
Recovery from fistula surgery is straightforward. Patients are advised to exercise the arm gently to encourage fistula maturation. Duplex ultrasound surveillance is used to monitor fistula development.
Frequently Asked Questions
A well-created and cared-for AV fistula can function for many years, often for the duration of a patient's dialysis treatment.
A proportion of fistulas fail to mature adequately. Angioplasty of a stenosed segment can often salvage the fistula.
When to Seek Medical Advice
- If you have been advised by your nephrologist that haemodialysis may be required in the future
- If your existing AV fistula is not working well
- For assessment and planning of dialysis access before starting haemodialysis