Name of the Procedure:

Repair, Acquired or Traumatic Arteriovenous Fistula; Extremities Common name(s): Arteriovenous Fistula (AVF) Repair

Summary

An arteriovenous fistula repair for the extremities involves surgically correcting an abnormal connection between an artery and a vein, usually caused by trauma or acquired conditions. This procedure aims to restore normal blood flow and prevent complications.

Purpose

The procedure addresses the abnormal blood flow caused by an arteriovenous fistula. The primary goals are to restore normal circulation, reduce swelling, alleviate pain, and prevent potential complications like clotting or heart failure.

Indications

• Trauma to the extremities resulting in an AVF.
• Symptoms such as swelling, pain, and discoloration of the affected limb.
• Presence of a pulsatile mass or abnormal blood flow sound.
• Diagnostic imaging confirming the existence of an AVF.
• Progressive symptoms or risk of serious complications.

Preparation

• Fasting for at least 8 hours prior to surgery.
• Discontinuation of certain medications as instructed by your physician.
• Preoperative imaging studies such as Doppler ultrasound or angiography to map the AVF.
• Routine pre-surgical assessments including blood tests and physical examination.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A careful incision is made over the site of the AVF.
3. Isolation: The surgeon identifies and isolates the AVF from nearby blood vessels.
4. Repair: The abnormal connection is then surgically closed or repaired using sutures or grafts to ensure normal blood flow.
5. Closure: The incision is closed with sutures or staples and bandaged.

Equipment used includes surgical instruments for cutting and suturing, imaging devices for guidance, and possibly graft materials for vessel repair.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the fistula and the patient's condition.

Setting

The procedure is performed in a hospital setting, typically in an operating room equipped for vascular surgery.

Personnel

• Vascular Surgeon
• Anesthesiologist
• Surgical Nurses
• Vascular Technologists (if imaging guidance is required)

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Damage to nearby nerves or blood vessels
• Blood clot formation
• Recurrence of the fistula
• Delayed wound healing

Benefits

• Restoration of normal blood circulation
• Relief from symptoms such as pain and swelling
• Prevention of severe complications like heart failure or limb ischemia Benefits can be realized shortly after surgery with improvements seen in the days to weeks following the procedure.

Recovery

• Post-operative monitoring in the hospital for a few days.
• Pain management through prescribed medications.
• Instructions to keep the surgical site clean and dry.
• Gradual return to normal activities within 2 to 4 weeks.
• Follow-up appointments to monitor healing and blood flow.

Alternatives

• Conservative management with regular monitoring.
• Endovascular procedures like coil embolization.
• Pros and cons: Surgical repair provides a definitive solution but involves more significant risks and recovery time compared to minimally invasive methods.

Patient Experience

During the procedure, the patient is under anesthesia and will not feel any pain. After the surgery, there may be pain and swelling at the incision site, managed with medications. Discomfort typically subsides within a week, and most patients are able to resume normal activities gradually.

Pain management includes prescribed pain relief medications, and comfort measures such as elevating the affected limb and keeping the incision area clean to prevent infection.