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About AV Fistula

AV fistula (AVF) stands for arteriovenous fistula, which is a surgical connection created between an artery and a vein with the help of AV shunt. The role of AV fistula is to provide a channel or access point that is capable of withstanding the dialysis treatment multiple times without causing any damage. It is generally created in the arm or legs. The fistula is important for people who have chronic kidney diseases and have to receive hemodialysis 2-3 times a week.

If your kidney doctor or nephrologist has recommended that you should undergo AV fistula surgery for dialysis, you can get in touch with Pristyn Care and consult our vascular specialists in Agra at your convenience.

Overview

TAGS

Types of AV Fistula for Dialysis

Radial Cephalic fistula

Brachial Cephalic fistula

Brachial Basilic fistula

Risks & Complications

Clotting of the fistula

Steal Syndrome

Infection

Swelling

AV Fistula Maturation (6S Rule)

The flow within the fistula is greater than 600 mL/min.

Diameter of the fistula is around 6mm.

It must be 6mm below the skin.

Minimum 6 cm of the vein is used for cannulation.

A thorough examination of the fistula is needed after 6 weeks.

Treatment

Doctors performing laser surgery for av fistula

Diagnosis for AV Fistula

Before creating a vascular access (AV fistula) for dialysis, the vascular surgeon will ask your medical history to identify if you have any other underlying conditions. Preoperative diagnosis of the veins and arteries is also done. A thorough diagnosis of the arterial and venous system is necessary, especially for the patients who have grade 4 or 5 Chronic Kidney Disease (CKD) or other conditions like diabetes, peripheral vascular disease, etc.

Various imaging tests, such as doppler ultrasound, CT angiogram, MRA (magnetic resonance angiogram), modified Allen test, and other tests are also done to examine the axillary, brachial, radial, and ulnar pulses in both upper extremities.

An Ultrasound or angiogram is used to determine the size and depth of the arteries and the veins to decide whether or not the blood vessels can support the AV fistula.

The whole analysis is also known as vessel mapping. The results of the diagnostic procedures will help to determine whether AV fistula surgery is the safest option for dialysis access or not.

AV Fistula Surgery for Dialysis

Before creating a vascular access (AV fistula) for dialysis, the vascular surgeon will ask your medical history to identify if you have any other underlying conditions. Preoperative diagnosis of the veins and arteries is also done. A thorough diagnosis of the arterial and venous system is necessary, especially for the patients who have grade 4 or 5 Chronic Kidney Disease (CKD) or other conditions like diabetes, peripheral vascular disease, etc.

Various imaging tests, such as doppler ultrasound, CT angiogram, MRA (magnetic resonance angiogram), modified Allen test, and other tests are also done to examine the axillary, brachial, radial, and ulnar pulses in both upper extremities.

An Ultrasound or angiogram is used to determine the size and depth of the arteries and the veins to decide whether or not the blood vessels can support the AV fistula.

The whole analysis is also known as vessel mapping. The results of the diagnostic procedures will help to determine whether AV fistula surgery is the safest option for dialysis access or not.

AV fistula surgery for dialysis, also known as Vascular Access Surgery, is usually performed through minimally invasive techniques. The doctor will administer local anesthesia in the access site and the following steps will be carried out-

  • A small incision will be made in the surgical site to gain access to the arteries and veins. Generally, the non-dominant arm is chosen for the procedure, also known as the access arm.
  • The artery (that carries blood from the heart) and vein (that carries blood back to the heart) are joined together to make a small channel, i.e., fistula.
  • Once the AV fistula for dialysis is created, the cut is closed with the help of dissolvable stitches.

The surgery is performed on an outpatient basis and takes around an hour to complete. The patient is discharged on the same day and the surgeon will give you specific instructions that will help you to take care of the access arm.

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Frequently Asked Questions

What is the right time to undergo vascular access surgery or AV fistula surgery for dialysis treatment?

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Why do the veins need to be enlarged for hemodialysis treatment?

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Which artery and vein is used commonly to create an Arteriovenous fistula for dialysis?

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What are the common types of arteriovenous fistula that are created for dialysis treatment?

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How much does AV fistula surgery for dialysis cost in Agra?

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How do I find the best vascular surgeon in Agra for AVF surgery?

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Where can I find the best vascular surgeons for AV Fistula?

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What is the alternative method to AV fistula for dialysis?

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Which method of vascular access is preferred by the doctors?

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Is vascular access surgery covered under health insurance at Pristyn Care?

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Does Pristyn Care provide No-Cost EMI service for AV fistula for dialysis in Agra?

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How do you know that an arteriovenous fistula is mature and ready to handle the dialysis treatment?

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Will AV fistula surgery leave a scar?

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How long will it take to recover after AV fistula surgery?

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When should you take follow-up after AVF surgery?

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What is the need of arteriovenous fistula for dialysis?

Arteriovenous fistula is very important for patients who have to undergo dialysis due to kidney failure. During dialysis, the impure blood is taken out from the veins, filtered outside the body with the help of a dialysis machine, and then the pure blood is transferred to the arteries.

The same procedure is repeated multiple times until the patient finds a healthy kidney for transplant.

To make the dialysis successful, it is important that the blood vessels can bear the pressure of the blood entering them. Typically, the veins are small and only about 30-40 ml of blood flows through them per minute. The goal is to make the veins strong and thick enough that they can tolerate the blood pressure and frequent insertion/exertion of the dialysis needles.

This is why an arteriovenous (AV) fistula is needed for long-term and adequate hemodialysis treatment.

How is the AV fistula used for dialysis treatment?

Once the arteriovenous fistula is created, it is left to heal. The actual use of the fistula begins when the first session of hemodialysis takes place. The patient is given local anesthetic cream to apply on the skin above the fistula, and two needles are inserted into it. One needle goes into the vein and the other goes into the artery. The arterial needle is connected to the vein and it carries the blood from the body to the dialyzer. The venous needle is connected to the artery and carries fresh and filtered blood back to the body.

The entire dialysis treatment takes around 3-4 hours, and each time the needles are connected and ejected from the blood vessels. Throughout the treatment, you won’t feel any kind of pain or discomfort.

What are the advantages of the AV fistula created for dialysis?

  • AV fistula is a long-lasting and more effective form of vascular access.
  • The procedure doesn’t involve the implantation of any synthetic or artificial material in the body.
  • Creates a safe channel for the blood flow and decreases the time of dialysis as well.
  • The AV fistula has minimal risks of infection and is less prone to clotting and other problems associated with dialysis access.
  • Recovery after the AV fistula surgery is fast and the patient will be able to resume daily activities as expected.

What are the risks associated with arteriovenous fistula (AVF) surgery?

Similar to other surgeries, the creation of an AV fistula also has some potential risks and complications. However, only a minority of the patients experience these complications.

  • Clotting of Fistula- Blood clotting may happen and disrupt the blood flow in the arteries or veins.
  • Steal Syndrome- When a large amount of blood flows from the artery to the vein, it can reduce the blood supply in the hands and fingers, leading to symptoms like cold and numb fingers. This phenomenon is known as steal syndrome, and if this happens, revision surgery will be performed to improve the blood flow.
  • Infection- Another possible complication of the arteriovenous fistula is wound infection. It will require antibiotics for treatment.
  • Swelling- This complication usually arises when a graft is used to create the fistula. It can be resolved by raising the arm above the level of the heart and performing some finger exercises.

Most of the risks associated with surgery can be mitigated by an experienced vascular specialist.

Take Proper Care of the Arteriovenous Fistula for Dialysis

  • Keep the AVF clean. Wash the arm every day, especially before the dialysis treatment.
  • Make sure that you don’t press the fistula or wear tight clothes as it can compress the arm.
  • The kidney doctor will teach you how to check the pulse or vibration through the fistula. You will have to check the pulse every day to ensure that the fistula is not blocked.
  • Never allow the lab technician or doctors to take blood pressure or blood samples from the arm that has the fistula. It will increase the risk of damage to the fistula and blood clotting.
  • Avoid lifting heavy objects as it will put direct pressure on the fistula.
  • Make sure that the site of the AVF is not cut or injured.

Book An Appointment with Pristyn Care Vascular Specialists in Agra

To consult the expert vascular surgeons in Agra for AVF surgery, i.e., to create an arteriovenous fistula for dialysis, you only need to get in touch with us. You can use any of the following ways to schedule your appointment-

  • Give us a call on the number given at the top of the page and talk to our medical coordinators directly.
  • Fill out the “Book Appointment” form and submit your details. Our representatives will get back to you and discuss the appointment details.
  • Download the Pristyn Care mobile application on your device and confirm the appointment directly with the doctor of your choice.

You can schedule the consultation before and after the procedure at your convenience.

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