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Last Updated: Apr 11, 2024

Fistula For Dialysis!

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Dr. Rahul N SVascular Surgeon • 21 Years Exp.MBBS, MS - General Surgery, MCh - Vascular Surgery, F.V.E.S
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An arteriovenous fistula or AV fistula is a connection between the artery and vein made by a vascular surgeon at the time of hemodialysis. Hemodialysis is a treatment for kidney failure that involves a machine called dialyzer to filter the blood and remove the toxins. In order to gain a safe and easy access to the blood system during hemodialysis, the AV fistula is essential.

An AV fistula is placed in the upper arm and it causes extra pressure and extra blood to flow into the vein, thereby making it stronger and larger.

Benefits of AV Fistula

  1. Lower complication rates
  2. Less prone to injection or blood clotting
  3. Enables greater blood flow
  4. Relatively less expensive to maintain with a longer lifespan

Types of Fistula for Dialysis
All AV fistulas are created from the native blood vessels of the body, without any synthetic materials. The surgical process is quick and simple and requires a maturation time, in order to enable an increase and thickening of vessel walls.

  1. Radial Cephalic Fistula – This access involves a connection of the radial artery and cephalic vein. It is the hardest to create and has a lower blood flow than the other types. Typically the first choice for hemodialysis access, the radial cephalic fistula at the wrist is recommended.
  2. Brachial Cephalic Fistula – It is the easiest fistula that can be created by connecting the upper arm cephalic vein to the brachial artery. This access allows for a higher blood flow since the blood vessels in this part of the body are relatively larger. Also, it is easier to cannulate or introduce a tube into the vein, with a larger possible selection of cannulation sites.
  3. Brachial Basilic Fistula – This access is more complex to create and typically considered when multiple access procedures have failed previously. It requires the vein to be elevated and transposed in order to enable easy access. A mobilized vein from a deep location is connected to a superficial tunnel.

How does the AV Fistula Work?
Before surgery is done to insert the fistula, the surgeon may perform a vessel mapping test to analyze blood vessels and determine the best blood vessels to use. Once the surgery is performed, the fistula needs 2 to 3 months to mature and accustomed to the body before it can be used for hemodialysis.

At the start of the dialysis, the patient or healthcare provider inserts two needles into the access. One needle referred to as the arterial needle carries the blood from the body to the dialyzer machine. The dialyzer performs the kidney’s function to filter out the toxins and then it returns the filtered blood through another tube. The other venous needle carries the filtered blood back to the body.

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