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AV Fistula Surgery

AV fistula surgery is the standard technique for better vascular access for patients who need constant dialysis therapy for end-stage renal sickness or kidney disappointment. AV fistula for dialysis makes it a lot more straightforward for the dialyzer to carry blood in and out of the body on various times. Get in touch with the best vascular specialists at Pristyn Care and experience a variety of cutting-edge surgical procedures carried out.

AV fistula surgery is the standard technique for better vascular access for patients ... Read More

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    Dr. Bikram Kesharee Mohanty (2YwpBCn51X)

    Dr. Bikram Kesharee Moha...

    MBBS, MS, DNB (CTS), Sr. Consultant Cardio-Thoracic & Vascular Surgery (Adult & Paediatric)
    25 Yrs.Exp.

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    Delhi

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    Dr.  Deepak Kumar Maharana (3JG5D9NlZx)

    Dr. Deepak Kumar Mahara...

    MBBS, MS, MCh (Cardio-Vascular Thoracic Surgery)
    23 Yrs.Exp.

    4.5/5

    23 + Years

    Hyderabad

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    Dr. Milind Joshi (g3GJCwdAAB)

    Dr. Milind Joshi

    MBBS, MS - General Surgery
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    23 + Years

    Pune

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    Dr. S. Kumarswamy (vFaB5PSDS4)

    Dr. S. Kumarswamy

    MBBS, MS-General Surgery
    20 Yrs.Exp.

    4.7/5

    20 + Years

    Coimbatore

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  • What is an AV Fistula?

    An arteriovenous (AV) fistula is a connection or passageway between an artery and a vein. Normally, arteries and veins are separate and carry blood in different directions. In the case of an AV fistula, an abnormal connection forms between an artery and a vein, allowing blood to flow directly from the artery into the vein without passing through the normal capillary network.

    AV fistulas are often created deliberately in medical procedures, such as for hemodialysis treatment in patients with kidney failure. The AV fistula provides a high-flow pathway that allows repeated access to the bloodstream for dialysis procedures. Once the AV fistula is created, the vein becomes thicker and wider over time, allowing better blood flow during dialysis treatment.

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    What Are the Types of AV Fistula?

    There are different types of AV fistulas that can be created for dialysis access. The choice of AV fistula type depends on various factors, including the patient’s vascular anatomy and overall health and the doctor’s recommendation, here are the different types of AV fistulas:

    • Radiocephalic Fistula: Radiocephalic fistula is the most common and used form of AV fistula. It involves connecting the radial artery in the forearm to a nearby cephalic vein. The radiocephalic fistula is mostly used because of its high success rate, good blood flow, and lower risk of complications. It is generally the primary choice when the patient’s blood vessels are suitable for the treatment.
    • Brachiocephalic Fistula: A brachiocephalic fistula involves connecting the brachial artery in the upper arm to the cephalic vein in the upper arm or shoulder area. It is another possible substitute when the radial artery is not suitable for a radiocephalic fistula. The brachiocephalic fistula provides better blood flow rates and is a more reliable and durable option.
    • Brescia-Cimino Fistula: The Brescia-Cimino fistula is a type of AV fistula that connects an artery in the upper arm to a vein that is nearby, which is generally the cephalic vein. It can be either a side-to-side or an end-to-side connection. The Brescia-Cimino fistula is similar to the radiocephalic fistula but may involve a different vein or anastomotic technique.
    • Upper Arm Loop/Graft Fistula: When the patient’s blood vessels are not suitable for a direct AV fistula, an AV graft is advised by the doctor. In AV graft, a synthetic tube (graft) is placed between an artery and vein to create the connection for dialysis. The graft is generally placed in the upper arm, forming a loop configuration. Grafts are used by vascular specialists when the patient’s blood vessels are small, weak, or unsuitable for a fistula.

    The choice of AV fistula type completely depends on individual patient factors, such as the condition of blood vessels, vessel size, quality, and suitability for surgery. The doctor will evaluate the patient’s vascular anatomy and determine the most appropriate type of AV fistula for optimal dialysis access.

    Diagnostic Tests and Health Screenings Done Before AV Fistula

    The diagnosis of an AV fistula generally involves a combination of medical history evaluation, physical examination, and diagnostic tests. Here are some common methods used to diagnose AV fistulas:

    • Medical history and physical examination: The doctor will review your medical history and ask about any symptoms you may be experiencing. They will also perform a physical examination to assess for signs such as swelling, discoloration, pulsation, or a bruit (a humming sound caused by turbulent blood flow) over the suspected area of the AV fistula.
    • Doppler Ultrasound: This non-invasive test uses sound waves to create images of blood vessels and assess blood flow patterns. Doppler ultrasound can help identify the presence and location of an AV fistula, as well as evaluate its size and blood flow characteristics.
    • Magnetic Resonance Angiography (MRA): MRA uses magnetic fields and radio waves to produce detailed images of blood vessels. It can provide information about the anatomy and blood flow within the vessels, aiding in the diagnosis of AV fistulas.
    • Computed Tomography Angiography (CTA): CTA involves the injection of a contrast dye followed by a CT scan to visualize blood vessels. It can provide detailed images of AV fistulas and surrounding structures.
    • Angiography: Angiography is an invasive procedure that involves the injection of a contrast dye into blood vessels followed by X-ray imaging. It provides detailed images of the blood vessels and can precisely locate and characterize AV fistulas. 

    The specific diagnostic approach may vary depending on the location of the AV fistula and the doctor’s preferences. Your healthcare provider will determine the most appropriate tests based on your medical circumstances.

    How to Prepare Before AV Fistula Surgery?

    Before undergoing AV fistula surgery, there are several preparations that may be necessary to ensure the procedure goes smoothly.

    Here are some common steps taken before AV fistula surgery:

    • Medical evaluation: The doctor will conduct a thorough medical evaluation to assess your overall health and identify any underlying conditions that may affect the surgery or healing process. This may involve reviewing your medical history, performing a physical examination, and ordering blood tests or other diagnostic tests as needed.
    • Current medication: The concerned doctor will review your current medications, including prescription drugs, over-the-counter medications, and supplements. Certain medications, such as blood thinners, may need to be adjusted or temporarily stopped prior to surgery to minimize the risk of excessive bleeding during the procedure.
    • Consumption of food: The patients are generally instructed by the doctors to avoid eating or drinking anything for a specified period before the surgery. This is majorly done to reduce the risk of complications related to anesthesia.
    • Preoperative instructions: Your healthcare provider will provide you with specific preoperative instructions to follow. These may include guidelines on showering or bathing before surgery, restrictions on eating or drinking, and any necessary changes to regular medication routines.
    • Anesthesia consultation: If the AV fistula surgery requires anesthesia, you may need to undergo a separate consultation with an anesthesiologist. They will review your medical history, discuss anesthesia options, and address any concerns or questions you may have.
    • Transportation arrangements: Since AV fistula surgery is mainly performed as an outpatient procedure, you may need to arrange for transportation to and from the surgical facility. It is generally advised not to drive yourself after receiving anesthesia.

    It is very important to closely follow the instructions provided by your healthcare medical team to ensure a successful and safe AV fistula surgery. If you have any questions or concerns about the preparations, it is best and advised to discuss them with your healthcare provider well in advance of the scheduled surgery date.

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    What Happens During AV Fistula Surgery?

    The AV fistula methodology is a careful intercession that includes making an association between a supply route and a nearby vein to give admittance to hemodialysis.

    Here is an outline of the steps followed in AV Fistula:

    • Sedation: The AV Fistula surgery is ordinarily performed under local anesthesia, which numbs the careful region while permitting the patient to stay alert. At times, general sedation might be utilized, especially on the off chance that extra methods or mediations are arranged close by the fistula creation.
    • Incision: The doctor makes a cut over the chosen region where the corridor and vein are available. The most widely recognized areas for AV fistula creation are the lower arm or the upper arm.
    • Arterial and venous exposure: The doctor cautiously uncovers the artery and vein in the surgical area. The particular corridor and vein chosen rely upon the patient’s vascular life systems and the doctor’s inclination.
    • Anastomosis: The doctor makes an association or anastomosis between the artery and the vein. This is commonly finished by making a little opening in the artery and joining it to the vein utilizing stitches or clasps. The association permits blood vessel blood to stream straightforwardly into the vein.
    • Bloodstream assessment: After making the connection, the specialist assesses the blood course through the fistula to guarantee legitimate capability. This might include utilizing Doppler ultrasound or different procedures to evaluate the stream rate and affirm that the fistula is working properly.
    • Closure: When the bloodstream is affirmed to be good, the doctor closes the incision with stitches or staples. Sterile dressings and wraps are applied to the careful site.
    • Post-operative care: After the AV fistula surgery, the patient is observed in a recuperation region to guarantee stable essential signs. The medical services group gives directions on injury care, impediments, and any fundamental subsequent arrangements. Following the AV fistula system, the recently made fistula expects time to develop and foster sufficient bloodstream.

    What Are the Benefits of AV Fistula Surgery?

    AV fistula surgery offers several benefits for individuals requiring long-term hemodialysis or in specific cases where AV fistulas are used for other medical purposes. Here are some of the benefits of AV fistula surgery:

    • Improved hemodialysis access: AV fistulas are the preferred method of vascular access for hemodialysis. Compared to other types of access, such as central venous catheters or synthetic grafts, AV fistulas have a lower risk of complications such as clotting. They provide a reliable and durable access point for repeated hemodialysis sessions.
    • Long-term functionality: AV fistulas have the potential to last for many years, providing a stable and long-term access site for hemodialysis. This reduces the need for frequent interventions or replacements compared to other types of vascular access.
    • Lower infection risk: AV fistulas have a lower risk of infection compared to central venous catheters or synthetic grafts. By using the patient’s own natural blood vessels, the risk of introducing foreign materials into the bloodstream is minimized, reducing the chances of infection.
    • Improved dialysis efficiency: AV fistulas facilitate higher blood flow rates during hemodialysis, allowing for more efficient removal of waste products and better clearance of toxins from the blood. This can lead to improved dialysis outcomes and overall health.
    • Cost-effectiveness: AV fistulas are generally more cost-effective over the long term compared to other types of vascular access. They require fewer replacements, have lower maintenance costs, and reduce the need for expensive procedures or interventions associated with complications.
    • Preservation of central veins: AV fistulas help preserve the central veins, as they do not require the insertion of catheters or synthetic materials into these vessels. Preserving central venous access is important for future medical interventions or procedures that may require access to these veins.
    • Medical applications: In some cases, AV fistulas may be used for purposes other than hemodialysis. They can be utilized to improve blood flow in specific medical conditions, such as certain congenital heart defects, or for measuring blood pressure in specialized diagnostic procedures.

    The benefits of AV fistula surgery may vary depending on individual factors, such as overall health, underlying medical conditions, and specific needs. Your healthcare provider can provide personalized information and guidance regarding the potential benefits of AV fistula surgery in your particular situation.

    Possible Risks and Complications Of AV Fistula Surgery

    AV fistula surgery is generally considered a safe and effective procedure with a low risk of complications. However, like any surgical procedure, there are potential side effects and risks associated with AV fistula surgery. Here are some of the minimal side effects that the patient may experience:

    • Bleeding: Some bleeding is common after AV fistula surgery, but it is typically minimal and resolves on its own. In rare cases, excessive bleeding may require medical attention.
    • Infection: There is a small and rare risk of infection at the surgical site. To minimize this risk, sterile techniques are followed during the procedure, and antibiotics may be given before and after surgery. If signs of infection (such as redness, swelling, warmth, or pus) occur, medical attention should be provided without any delay.
    • Bruising and hematoma: Bruising and hematoma (a localized collection of blood) can occur at the surgical site. They are usually minor and resolve over time.
    • Pain and discomfort: Some degree of pain, swelling, and tenderness at the surgical site is common after AV fistula surgery. Pain medications and measures such as applying ice packs and keeping the arm elevated can help manage these symptoms.
    • Nerve injury: In rare cases, there is a possibility of nerve injury during the surgical procedure, which may lead to temporary or permanent numbness, tingling, or weakness in the arm.
    • Stenosis or thrombosis: Over time, AV fistulas can develop narrowing (stenosis) or clot formation (thrombosis), which can reduce blood flow. Regular monitoring and appropriate interventions, such as balloon angioplasty or thrombectomy, can help manage these complications.

    The risks and potential side effects of AV fistula surgery can vary depending on individual factors, such as overall health, the presence of underlying conditions, and the specific surgical approach used.

    Recovery Process of AV Fistula After Surgery

    The recovery process after AV fistula surgery for dialysis can vary depending on the individual patient’s medical condition and the extent of the surgery. The fistula will be ready for hemodialysis only when the vein enlarges enough to support dialysis treatment.

    The recovery process following arteriovenous (AV) fistula surgery involves a period of healing and rehabilitation. Here are some key aspects of the recovery process:

    • Hospital stay: After AV fistula surgery, you will typically spend a short period of time in the hospital for observation. The length of the hospital stay can vary but is generally short, ranging from a few hours to a couple of days.
    • Wound care: Proper wound care is essential for healing after surgery. Your healthcare provider will provide instructions on how to clean and care for the surgical incision site. This may involve keeping the area clean and dry, applying sterile dressings, and avoiding activities that could disrupt the healing process.
    • Pain management: It is common to experience some pain or discomfort at the surgical site after AV fistula surgery. Your healthcare provider may prescribe pain medications or recommend over-the-counter pain relievers to help manage any discomfort. Follow their instructions regarding medication usage.
    • Restrictions and activity modification: Following AV fistula surgery, you may be advised to limit certain activities that could put stress on the surgical site or affect the healing process. Your healthcare provider will provide specific instructions regarding activity restrictions, such as avoiding heavy lifting or strenuous exercise for a certain period of time.
    • Rehabilitation and physical therapy: Depending on your individual needs, you may be referred to a physical therapist or occupational therapist for rehabilitation. They can guide you through exercises and activities that promote recovery, strength, and mobility in the affected arm or leg.
    • Lifestyle modifications: If an AV fistula is created for hemodialysis access, you will receive guidance on how to care for and protect the fistula to maintain its long-term functionality. This may involve avoiding trauma to the arm, protecting the fistula during activities, and adhering to proper hygiene practices.
    • Follow-up Appointments: Regular follow-up appointments with the doctor is important to monitor the healing process and assess the functionality of the AV fistula. These appointments may involve physical examinations, imaging tests, or other assessments to ensure the fistula is functioning properly.

    Recovery times can vary depending on individual factors and the extent of the surgery, but most people can expect to resume normal activities gradually within a few weeks to months following AV fistula surgery.

    AV Fistula Surgery Cost in India

    The cost of AV fistula surgery in India can vary depending on several factors, including the city, hospital, surgeon, and any additional medical services required. This cost typically includes the surgical procedure, surgeon’s fees, anesthesia charges, hospital stay, and basic postoperative care.

     It Is important to note that the following cost estimates are approximate and can vary significantly:

    • Diagnostic Tests: Prior to surgery, certain diagnostic tests may be required to evaluate the suitability of the patient for AV fistula creation. These tests may include blood tests, imaging studies, and vascular mapping.
    • Hospital Stay: The duration of hospital stay for AV fistula surgery is usually short, typically ranging from a few hours to a couple of days. The cost of hospital accommodation, nursing care, and other related services can vary but depending on the hospital facility.
    • Medications and Consumables: The cost of medications, dressings, and other consumables used during and after the surgery will also be added to the overall expense.
    • Follow-up Visits: Postoperative follow-up visits may be required to monitor the healing process and assess the functionality of the AV fistula. The cost of these visits can vary depending on the consultation fees of the healthcare provider and any additional tests or procedures performed.

    FAQs Around AV Fistula Surgery

    How long does AV fistula surgery take?

    The AV fistula surgery is performed under local anesthesia, and the patient does not feel any kind of pain or discomfort during the surgical intervention. The complete duration of AV fistula surgery is around 1 to 2 hours long.

    How are AV fistulas repaired?

    AV fistula are repaired if it gets damaged. The repair may involve surgical or non-surgical techniques, depending on the severity of the damage. If the fistula fails entirely, another vascular access will be created by the surgeon.

    Is AV fistula surgery risky?

    AV fistula is a completely safe process, whereas, just like other surgical interventions, there are some minor risks, such as chances of infection, bleeding, and discomfort due to anesthesia.

    Is AV fistula surgery covered under insurance?

    The AV fistula surgery is covered under insurance, however, this insurance coverage depends on the health insurance plan of the patient. It is always suggested to consult with the insurance provider regarding the policy details before undergoing the AV fistula surgery.

    What happens if AV Fistula is left untreated?

    AV fistula should be treated within the right time being; if left untreated and ignored, it could lead to severe complications such as heart failure, blood clots, leg pain, and stroke or bleeding.

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    Content Reviewed By
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    Dr. Bikram Kesharee Mohanty
    25 Years Experience Overall
    Last Updated : May 16, 2024

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    Based on 91 Recommendations | Rated 5 Out of 5
    • YR

      Yukta Raina

      5/5

      I recently had av fistula treatment at pristyn care, and I am extremely satisfied with the outcome. The medical team displayed excellent professionalism and expertise, ensuring a successful procedure and a comfortable recovery. I highly recommend pristyn care for av fistula treatment based on the exceptional care provided.

      City : DEHRADUN
    • PC

      Pushpa Chaturvedi

      5/5

      I recently underwent AV fistula treatment at pristyn care, and I couldn't be happier with the care I received. The medical team was highly skilled and compassionate, ensuring a successful procedure and a smooth recovery. I highly recommend pristyn care for AV fistula treatment.

      City : JAIPUR
    • SB

      Shivangi Bharadwaj

      5/5

      The av fistula treatment I received at pristyn care was a remarkable experience. The medical team was attentive, reassuring, and went above and beyond to ensure my comfort throughout the procedure. I wholeheartedly recommend pristyn care for av fistula treatment based on the exceptional care and support I received.

      City : JAIPUR
    • DV

      Dashrath Vishwakarma

      5/5

      Pristyn Care's AV fistula procedure was efficient and yielded impressive results. The medical team was highly professional and ensured a smooth experience. I'm thankful to Pristyn Care for their expertise in AV fistula treatment.

      City : BANGALORE
    • SJ

      Shashikala Jaiswal

      5/5

      I contacted Pristyn Care for my AV fistula treatment, and I can say that the guidance I received from the medical team and doctors were commendable. From the initial consultation to the post-operative follow-up, their team of healthcare professionals provided comprehensive and knowledgeable guidance. Pristyn Care truly sets the standard for expert guidance in AV fistula treatment.

      City : CHANDIGARH
    • AB

      Anjali Bishnoi

      5/5

      My AV fistula surgery at Pristyn Care was one of the best experiences I had. Due to my health, I often need to visit hospitals and clinics. But I often feel disappointed with the staff. But Pristyn Care's staff was very helpful and helped me with all formalities, including admission, discharge, payment, and cab, and even provided free follow-ups. I appreciate their help.

      City : KOLKATA