What is an AV fistula?
AV fistula is a connection made by a vascular surgeon between an artery and a vein. Arteries carry blood from the heart to the body, and the veins carry it back to the heart. Connecting the vein to the artery allows the vein to increase in size which in turn allows blood to be drawn from the vein at high speeds needed for dialysis.
Is it a “major surgery”? Does it need admission?
While the surgery is not a major surgery and is done on day care basis it is important to understand that starting dialysis with a well functioning fistula will dramatically improve your chances of a healthy life on dialysis. The surgery may not be “major”, but an AV fistula created well in time has a major influence on long term outcomes!
How is it created?
Usually, AV fistula created in an operation theater by our surgeon and takes around one hour for its completion. An incision made on the patient’s arm. This incision can either be towards the wrist or on the inside of the elbow.
When should it be created?
An AV fistula should be created about 6 months before the anticipated start of dialysis. A rule of thumb is to get it done once the blood creatinine levels are above 4 mg%. This is a very important part of preparation as you will face numerous problems if you start dialysis without an AV fistula.
Catheters are used for dialysis if an AV fistula is not ready and such patients are prone to serious complications like blood stream infections, infections in the heart, blockage and narrowing of important blood vessels, etc.
What care should I take before and after the surgery?
Exercise post-surgery: The strength of the fistula depends on the amount of exercise the access arm receives post-surgery. It is also important that you consult your doctor before you begin with these exercises as the kind of activities depends on the location of the fistula.
Clean Fistula is a safe Fistula: Always maintain the hygiene levels of the fistula arm.
Blood flow through the Fistula: The blood needs to flow through your AV Fistula effortlessly. Please ensure you do not put any pressure on that area especially while sleeping.
Check for Blood clots: Check the blood flowing through your fistula daily by gently pressing it with cleans fingers and feeling the “thrill” it makes. A weak or absent “thrill” demands a visit to your nephrologist.