Name of the Procedure:

Autogenous Arteriovenous (AV) Fistula Creation for Hemodialysis

• Common Names: AV Fistula, Dialysis Fistula
• Technical/Medical Terms: Autogenous AV Fistula Creation, Hemodialysis Vascular Access Surgery

Summary

An autogenous AV fistula is a surgical procedure that creates a connection between an artery and a vein in patients who require hemodialysis. This connection allows for easier and more efficient access to the bloodstream during dialysis treatments.

Purpose

• Addresses: End-stage renal disease (ESRD) requiring hemodialysis
• Goals/Outcomes: Provide a reliable vascular access site for hemodialysis, enhance blood flow, and reduce complications compared to other access types like central venous catheters.

Indications

• Symptoms/Conditions: Advanced kidney failure, ESRD requiring ongoing hemodialysis.
• Patient Criteria: Suitable vein and artery size and quality, patient assessed for potential complications like infections or clotting disorders.

Preparation

• Pre-Procedure Instructions:
  • Fasting for a few hours before the surgery
  • Medication adjustments as directed by the healthcare provider

• Diagnostic Tests/Assessments:

  • Vein mapping via ultrasound
  • Blood tests to check clotting function and general health

  Procedure Description

  1. Anesthesia: Local or general anesthesia administered.
  2. Incision: A small incision made near the chosen site (typically forearm or upper arm).
  3. Connection: Surgeon identifies and connects an artery to a vein, allowing arterial blood to flow directly into the vein.
  4. Closure: Incision closed with sutures or surgical staples.
  5. Monitoring: Patient monitored for immediate complications post-surgery.

Duration

• The procedure typically takes about 1 to 2 hours.

Setting

• Performed in a hospital operating room or specialized surgical center.

Personnel

• Healthcare Professionals: Vascular surgeon, surgical nurses, anesthesiologist.

Risks and Complications

• Common Risks: Infection at the surgical site, bleeding, swelling, pain.
• Rare Risks: Blood clot formation, poor fistula maturation, damage to nearby nerves, steal syndrome (reduced blood flow to the hand).

Benefits

• Expected Benefits: Long-term, reliable access for hemodialysis, lower risk of infection and clotting compared to catheters, improved quality of life.
• Realization Time: Fistula generally takes 6 weeks to 3 months to mature before it can be used for dialysis.

Recovery

• Post-Procedure Care:
  • Keep the surgical site clean and dry.
  • Avoid heavy lifting or strenuous activities for several weeks.
  • Follow prescribed medication regimen (e.g., antibiotics, pain management).
• Expected Recovery Time: Initial healing in a few weeks, full maturation in 6 weeks to 3 months.
• Follow-Up: Regular check-ups to monitor fistula maturity and function.

Alternatives

• Other Treatment Options:
  • Central venous catheter
  • AV graft
• Pros and Cons:
  • Central Venous Catheter: Immediate use but higher infection and clotting risk.
  • AV Graft: Quicker use than fistula but higher chance of complications over time.
  • AV Fistula: Best long-term outcomes but requires maturity period before use.

Patient Experience

• During the Procedure: Under anesthesia, patient experiences minimal to no pain.
• After the Procedure: Initial soreness and swelling managed with pain relief measures, significant improvements in dialysis efficacy once fistula is mature, ongoing care to ensure fistula remains functional and healthy.