Dialysis Arteriovenous Fistula

Dialysis Arteriovenous Fistula Explained

The kidneys clean the body's blood. When people go into kidney failure, something has to clean the blood. That's where dialysis enters the picture. A dialysis machine extracts the blood from the body, cleans it, and then returns it to the body. This is done three times per week. Continue reading to learn about dialysis arteriovenous fistula.

Vascular access means searching for veins and arteries in which this event can be done in a reliable fashion. One type of vascular access is arteriovenous fistula, and they are generally done in the forearm or upper arm.

Why is This Necessary?

About a year before a patient is thought to be in need of dialysis, the doctor will perform the dialysis arteriovenous fistula. This is when an artery is surgically joined to a vein in order for the vein to better handle the volume of blood coming back into the body. It helps dialysis.

It also reduces the risk of infection from catheters, although a catheter will be used while the fistula matures (becomes strong enough to handle the load of arterial blood into the vein). An AV fistula will allow dialysis for many years.

Healthy Arteries and Veins

A doctor will test the patient through many means to ascertain if the arteries and veins in the forearm and/or upper arm are healthy enough to take the fistula. A dye is sometimes run through the veins to provide contrast, so the doctor will see which veins are healthy enough for the fistula. A duplex ultrasound will show the doctor how the blood flows through the veins. A pulse volume recording shows the doctor the amount of blood flowing through the arteries.

Of course, blood pressure as well as circulatory problems will be studied.

About the Surgery

Arteriovenous fistula surgery will happen in the hospital at the outpatient level. The patient will remain in hospital for an hour or two to recuperate. Pain medications may be administered for the patient's comfort and the arm (or leg) will be elevated to prevent swelling.

The AV fistula will strengthen over the course of the next few weeks. Dialysis may begin in these weeks when the fistula is strong enough to take a needle. The doctor might give the patient a few exercises to do in order to further strengthen the fistula. The doctor will keep an eye out for infections and tell the patient how to care for the surgery site and the fistula.

Patients might encounter numbness in the arm (or leg) at the surgery site or tingling in the fingers of the arm operated on. This is normal and will go away on its own after a while. If it doesn't, then it could be serious. The fistula is borrowing blood from the lower extremity of the limb. The doctor should be notified immediately. He will perform a procedure that will rectify the situation.

What are the Complications?

There could very well be complications following the fistula:

  • Infection
  • Bleeding or leakage from the incision
  • Fever
  • Blood clots
  • Aneurysm
  • Non-maturation (procedures can rectify this)
  • Veins grow too large (procedures can rectify this)
  • Narrow places (which will inhibit flow; procedures can rectify this)

Other Considerations

Dialysis arteriovenous fistula: The arm in which the fistula is placed will need to be preserved from things like blood pressure checks, IVs, having blood drawn, and shots of any type. Sleeping on the arm or carrying heavy things is a no-no. Clothing should be loose, and jewelry should be worn on the other arm. It goes without saying the access should be kept exquisitely clean.

The fistula will make the patient feel like a vibration or thrum is going through him. The doctor will show the patient how to feel for this vibration. If it isn't present, this could mean a problem. The patient should notify the doctor immediately.

Random Facts About AV Fistula

  • An arteriovenous fistula is called “abnormal”. This is because veins and arteries don't meet, except in need of a strong vein for dialysis.
  • Blood is taken out of the body through arteries and returned to the body in veins.
  • The most common is the radial artery and cephalic vein in the lower forearm.
  • AV fistula is superior to other forms of manipulation because it allows for a higher rate of blood flow.
  • It is natural, without allowing artificial materials into the body (which might become infected).
  • It is thought to clot less easily.
Last Reviewed:
July 12, 2017
Last Updated:
October 19, 2017