Arteriovenous Fistula or Vascular Access for Hemodialysis
What is an arteriovenous fistula?
An arteriovenous fistula (AVF) is the connection of a vein and an artery. An AVF is surgically created, usually in the forearm and most often under local anesthesia, as a day-case. Patients go home the same day several hours following the operation. A more complex procedure should be expected if the patient does not have a suitable vein in the forearm. These more complex procedures are usually done under general anesthesia and require a one day hospital stay. An ultrasound vein assessment is necessary prior to every operation as the location and quality of the vein determines the type and site of surgical procedure.
Why is an AVF created?
The surgical creation of an AV Fistula provides a long-lasting site through which blood can be removed and returned during hemodialysis. Hemodialysis is a technique of ‘blood cleaning’ or ‘filtering’ through a machine in cases where a patient’s kidneys have stopped working. There is also a different type of dialysis called peritoneal dialysis. Only hemodialysis requires an AV Fistula or other vascular access. Both alternatives, however, need to be first discussed with a nephrologist (kidney specialist). The fistula should be created ideally several months before the patient starts their hemodialysis as AVF needs to mature.
What to do following the surgery?
Following creation of an AVF, every patient is seen by a specialised nurse and kidney specialist on a regular basis. Prior to the first hemodialysis every patient must also be seen by a vascular specialist to assess the quality of the AVF. Regular feedback from the dialysis nurse is desirable as any AVF can develop narrowing or even a blockage in the future and early and adequate intervention can save the fistula. Any AVF can also get infected or can develop an aneurysm. Those situations need to be assessed and treated by the vascular surgeon. Patients with an already existing AVF should be aware of the fact that long-term surveillance is needed to keep their AVF working well. Potential future interventions to keep the AVF well working are usually performed with minimally-invasive techniques as a day-case procedure (endovascular procedure).