An Arteriovenous (AV) Fistula is an unusual link between an artery and a vein. It can occur naturally because of injury or trauma to the body or through genetic irregularities. But, AV fistula can also be surgically created when a hemodialysis procedure is opted for by those with end-stage kidney failure as treatment.
During haemodialysis, blood is drawn out of the body, cleaned by the artificial kidney called dialyzer mounted on a dialysis machine, and returned to the body. This process requires a supply of a large quantity of blood (around 200ml per minute) to the dialyzer for efficient dialysis. The blood flow in a normal vein is much lesser. By creating this surgical short circuit, more arterial blood will flow into the vein. This causes an increase in the size, thickness, and blood flow in the vein. It then becomes easy to puncture this vessel for hemodialysis.
Your doctor will examine the hand vessels and may ask for Doppler study which accesses the vessel size and blood flow.
The AVF procedure is a day care procedure. Associated medical conditions may indicate the need for prolonged hospitalization. If the blood flow through the surgical communication procedure is not optimum as felt by the doctor, you may require medications like Heparin to reduce chances of blood clotting and increase blood flow through the fistula. Otherwise, the patient will be sent home after a few hours.
Once diagnosed with kidney failure, it is important to preserve the non-dominant upper limb to make it available for the procedure at a later date. Avoid taking any injections or giving blood samples for laboratory investigations from this upper limb.
If maintained well, it can work for a lifetime. There will not be good flow through AV fistula and it may not work effectively if the blood vessels are not good and if there are frequent episodes of low blood pressure during dialysis or at any other time.
An antibiotic will be prescribed for 5 days if you also have a tube or catheter for dialysis at the time of this surgery; otherwise, you will be prescribed only suitable painkillers. Other than that, medications prescribed for chronic renal failure itself will need to be continued.
Yes. It is usually done under local (only the area of surgery will be numb) or regional (a large part of the limb will be numb) anesthesia. It takes around one hour to perform this surgery. Only in cases of difficulty does it take longer. If the blood vessels for any reason are not suitable at the distal part of the forearm or at the wrist, other sites may also be selected, like the elbow, the upper forearm or the upper arm.
AV fistula needs to mature for 4-6 weeks post surgery for sufficient development. In cases of thin veins or poor quality of blood vessels, this period might be longer. Your doctor will prescribe simple hand exercises to fasten the maturation.
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