All AVF for dialysis has very similar characteristics. They are all created by using native vessels without using any synthetic material. Three of the most commonly created fistula for dialysis are-

1: Radial Cephalic Fistula 

It is very difficult to create this type of fistula. The radial artery and the cephalic vein are connected for anastomosis. The radial cephalic fistula has lower blood flow as compared to the other two types but it preserves the arm vessels in a better way. It is usually the first choice for hemodialysis access. 

2: Brachial Cephalic Fistula 

This type of fistula is created using the cephalic vein in the upper arm and connecting it to the brachial artery. Since the size of the blood vessels in the arm is larger, the fistula is easy to create. It generally requires minimal dissection and also has a larger possible selection of cannulation sites. The brachial cephalic fistula permits more blood to flow through the blood vessels during dialysis treatment but also has a higher risk of steal syndrome. 

3: Brachial Basilic Fistula 

This type of arteriovenous fistula requires the vein to be elevated and transposed to achieve stable vascular access. The connection is made between a mobilized vein (deep vein) to a superficial artery. It can be preserved in a better way but also has a higher rate of patient morbidity as compared to other fistulas. It is typically created in patients who have had failed access procedures multiple times.

The steps a patient takes before the surgery can improve the outcome of the procedure. Thus, it is advised to be well-prepared in all aspects before undergoing the procedure- 

• Answer all the questions asked by the doctor regarding the medical history and medications. This includes prescriptions, OTC drugs, herbal treatments, and vitamins too. 
• Make the necessary modifications in diet and try to lose excess weight to improve your overall health. 
• Talk to the doctor to control high blood pressure as it can increase the risk of complications of AV fistula surgery. 
• Avoid drinking or eating 6-8 hours prior to the surgery. 
• Stop smoking entirely as it will delay the healing process and also make the blood vessels weak. 
• If any medications are prescribed by the doctor before starting the dialysis treatment, take them as directed without any failure. 

The AV fistula surgery is performed on an outpatient basis at a hospital by an experienced vascular surgeon. The surgical team will clean the surgery site and start anesthesia. General, local, or regional anesthesia may be used depending on the patient’s condition. 

The surgery will be performed in the following steps- 

• Once the anesthesia takes effect, an incision is made in the site. 
• The chosen vein and artery are identified and the blood flow through the chosen blood vessels is halted temporarily. 
• The artery and vein are adjoined without any external support through stitches and the blood flow is restored. 
• The incision is then closed and the fistula is left to mature over the next several months.

Immediately after the surgery, the patient is transferred to the observation room. A tube may be placed in the windpipe to control breathing after general anesthesia is given. 

The surgical team will monitor the vital signs and other critical body functions for the next few hours. Once everything is normal, the patient is cleared for discharge. Before leaving the hospital, the doctor provides a recovery plan that consists of the dos and don’ts after the surgery.

Externally, there won’t be significant changes. Internally, the patient will be able to see the thickened vein that will be used for dialysis access. A pulse can also be felt in the blood vessels.

The cost of AV fistula surgery in India ranges from Rs. 80,000 to Rs. 1,50,000 approximately. The exact cost may vary based on the following factors- 

• Complexity of the procedure (veins used to create AV fistula)
• Surgeon’s fee 
• Diagnostic tests 
• Risks and complications 
• Anesthesia charges 
• Hospital-related expenses 
• Post-surgery care and follow-ups