Arterio-venous Fistula Creation

What is an AV fistula?

For long term hemodialysis the best means to access the blood stream is by an AV fistula. Placement of plastic dialysis catheters increases the risk of infection at the site of insertion leading to damage and narrowing of the lining of the blood vessels and the blood vessel becomes incompatible for further insertion of plastic catheters. With the creation of an AV fistula, adverse outcomes in the blood vessels are eliminated.

How is an AV fistula created?

  • An operation is required to create an AV fistula which is carried out under general/local anesthesia. The surgery generally takes around 2 hours.
  • A cut or incision is made at the patient’s arm which can be either towards wrist or at the inside part of the elbow.
  • 2-4 centimeters long incision or cut is made in the wrist and the elbow respectively.
  • If the creation of fistula is not possible from the veins of the arm, a section of the vein can be harvested from elsewhere or an artificial blood vessel can be used to create the fistula. Though the fistulas function in the same way, the procedure for grafting and creation of artificial fistula takes a longer time.
  • The fistula which is created will generally take about 6 weeks or more to mature. There might be a feeling of changes in the circulation in the arm. Any feeling of coldness or pain after the creation of the fistula should be reported to the doctor.

How is an AV Fistula take care of?

  • Firstly maximum care should be taken during the creation of AV fistula.
  • The arm is generally wrapped with soft dressing to keep it warm.
  • To avoid dehydration which forms clots which can further block the fistula, the patient’s dry weight is slightly increased during hemodialysis.
  • Aspirin is later administered which further reduces the chances of the fistula clotting.

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Dr. Ajay Shetty.

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Dr. Sushma Rani Raju.

Consultant - Nephrology

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