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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 an AV shunt. The role of the 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 Pune at your convenience.

USFDA Approved Procedures

USFDA Approved Procedures

No Cuts. No Wounds. Painless*.

No Cuts. No Wounds. Painless*.

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Insurance Paperwork Support

1 Day Procedure

1 Day Procedure

Pristyn Care Doctors

Overview

know-more-about-AV Fistula-treatment-in-Pune
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.
Doctor-performing-AV Fistula-surgery-in-Pune

Treatment

Diagnosis for AV Fistula

Before creating a vascular access (AV fistula) for dialysis, the vascular surgeon will ask about 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 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 about 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 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.

Why Pristyn Care?

Delivering Seamless Surgical Experience in India

01.

Pristyn Care is COVID-19 safe

Your safety is taken care of by thermal screening, social distancing, sanitized clinics and hospital rooms, sterilized surgical equipment and mandatory PPE kits during surgery.

02.

Assisted Surgery Experience

A dedicated Care Coordinator assists you throughout the surgery journey from insurance paperwork, to free commute from home to hospital & back and admission-discharge process at the hospital.

03.

Medical Expertise With Technology

Our surgeons spend a lot of time with you to diagnose your condition. You are assisted in all pre-surgery medical diagnostics. We offer advanced laser and laparoscopic surgical treatment. Our procedures are USFDA approved.

04.

Post Surgery Care

We offer free follow-up consultations and instructions including dietary tips as well as exercises to every patient to ensure they have a smooth recovery to their daily routines.

Pristyn Care in Numbers

2M+

Happy Patients

150+

Clinics

45+

Cities

150K+

Surgeries

400+

Doctors

800+

Hospitals

Frequently Asked Questions

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

Doctors generally recommend that the patients undergo AV fistula surgery at least six months before the first session of dialysis treatment is scheduled. The fistula may take several weeks to heal and become sturdy enough to withstand the dialysis.

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

The normal veins in the body carry smaller amounts of blood as compared to arteries which makes it harder for the dialysis machine to filter blood efficiently. The AV fistula makes extra blood flow through the veins regularly that leads to enlargement of the vein and makes it stronger. Untreated veins would collapse due to repeated needle insertions and under strong suction. Thus, it is crucial that the veins are enlarged and strong to bear the extra pressure and extra blood flow.

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

In most cases, the radial artery and the cephalic vein in the patient’s wrist are combined to create the AV fistula for dialysis treatment.

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

There are two common types of arteriovenous fistulas created for dialysis-

  • Distal AVF, also known as radial-cephalic fistula or Cimino fistula, is created by using the radial artery and the cephalic vein in the wrist.
  • Proximal fistula, which can be created using the brachial artery and cephalic vein in the proximal forearm or by using the brachial artery and the basilic vein in the upper arm.
How much does AV fistula surgery for dialysis cost in Pune?

On average, AV fistula surgery for dialysis will cost you around Rs. 80,000 to Rs. 1,50,000. This is only an estimated cost that may vary based on factors, such as type of fistula created, doctor’s fee, graft/shunt cost (if any), diagnostic tests, etc.

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

To find the best vascular surgeon who can perform AV fistula surgery for dialysis as well as other vascular access surgeries safely, follow the tips below-

  • Talk to your nephrologist or kidney doctor for reference.
  • Make a list of doctors available nearby with a good reputation and proper qualifications and certifications.
  • See how many years of experience the doctor has.
  • Check the hospital or clinic the doctor is associated with and its reputation.
  • Review the testimonials of previous patients who have gotten treatment from the doctor.
Where can I find the best vascular surgeons for AV Fistula?

Whether you are living in Pune or any other city in India, Pristyn Care is the best place to find the most qualified and experienced surgeons. We have a dedicated team of vascular surgeons who have more than 15 years of experience in performing vascular access surgeries safely. You can rely on their expertise and get the respective treatment from them.

What is the alternative method to AV fistula for dialysis?

The alternative method used for patients who cannot undergo AV fistula surgery due to weakness in blood vessels is AV graft surgery or venous catheter. In the graft surgery procedure, an artificial vein is installed in the body that allows dialysis. If immediate dialysis is required, the same can be done with the help of a venous catheter until the long-term solution is created.

Which method of vascular access is preferred by the doctors?

Among the three possible vascular access methods- AV fistula, AV graft, and venous catheter, AV fistula is a preferable method for dialysis because-

  • It provides good blood flow for dialysis treatment.
  • The fistula lasts longer than other types of access.
  • The AV fistula is less likely to get infected and lead to other complications.
Is vascular access surgery covered under health insurance at Pristyn Care?

Yes. Whether you are undergoing arteriovenous fistula surgery for dialysis or any other form of vascular access surgery, the procedure will be covered under the health insurance policy. Thus, you can use the policy to cover the entire expense of the treatment.

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

Yes. We provide No-Cost EMI service for all types of treatment, including AV fistula creation for effective dialysis treatment regardless of the city. With this service, you can pay for the treatment in easy installments.

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

Fistula maturation is generally defined with the help of the 6S rule, which includes-

  • 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.
Will AV fistula surgery leave a scar?

As the skin is cut to create a fistula, there will be a visible scar on the skin. Over time, as the skin heals from the surgery, the scar will fade away and may become unnoticeable.

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

Generally, it will take almost a month or so to recover completely after undergoing an AV fistula or vascular access surgery. The exact recovery time will be different for each individual. Thus, the surgeon will give you an estimate and plan for faster recovery.

When should you take follow-up after AVF surgery?

You will have to take 2-3 follow-ups after undergoing AVF surgery for dialysis. The first follow-up will be recommended within 7-10 days to see if the body is healing properly. The second follow-up will be done after 3-4 weeks to ensure that the fistula is working and there are no complications. When the recovery is complete, the final follow-up will take place after 6 weeks to check whether the fistula has matured or not.

What is the need for an arteriovenous fistula for dialysis?

An 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.

An experienced vascular specialist can mitigate most of the risks associated with surgery.

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 Pune

To consult the expert vascular surgeons in Pune 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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