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.

Contact us to learn more