An AV Fistula is the term used for a surgically created connection between an artery and a vein, usually on the arm or forearm.
A Vascular Surgeon is the specialist for creating an AV Fistula, which serves as a lifeline for patients with end-stage disease of the kidneys requiring dialysis.
A surgically created AV Fistula for dialysis
The suitable place for surgical creation of an AV Fistula depends on the quality of veins. The preferred site is on the wrist, and if veins are not good on the wrist, the next site of preference is the elbow. Also, the left hand is preferred over the right hand.
A good ultrasound doppler of the arm and forearm veins (called as Doppler Vein Mapping) helps us to decide which is the best site for an AV Fistula surgery.
Surgery for AV fistula usually takes 2 hours, and once the surgery is complete, certain precautions need to be followed:
No BP measurement on the arm on which fistula is made
No needle prick, blood sampling from the arm
No lifting of heavy weight on the arm
After an AV fistula is surgically created, it needs a maturation time of about 4 - 6 weeks, after which it may be used for dialysis access. If used before this period, there are high chances of failure of the fistula.
A fully matured AV Fistula after 6 weeks, ready for dialysis access
The biggest advantage of an AV fistula is that it is a permanent solution for Dialysis throughout the lifetime of a patient, and carries minimal chances of failure and infection as it does not involve any artificial tube or graft to be placed inside the body.
If a regular AV fistula surgery is not possible due to unsuitable superficial veins on the arm, one of the deep veins may be used for creating an AV Fistula. The Basilic vein is mostly used, and the procedure is called as a Basilic Vein Transposition. This involves a major surgical procedure on the arm and a proper regional anaesthesia needs to be given.
Basilic Vein Transposition Surgery
If an AV fistula surgery is not possible due to unsuitable veins on the arms, a synthetic tube graft known as an AV graft may be surgically placed on the arm.
A surgically placed AV Graft for dialysis access
If an AV Fistula is failing, does not mature or gets blocked, there are many options for saving the fistula both surgically (thrombus removal) and endovascularly (Balloon angioplasty), to make it functional again.
A temporary venous access using different types of catheters may also be attained for dialysis, and involves placement of simple (Temporary) as well as complex (Permanent) catheters such as the PERMACATH for dialysis patients.
A PERMACATH has a life of approximately 6 months to 1 year, hence it is a good option for patients in which AV Fistula surgery is not possible because of unsuitable veins