Dialysis is a treatment recommended for people who have been diagnosed with kidney failure and have little kidney function. The goal of dialysis is to take over some of the kidneys’ vital functions, including filtering waste products and regulating certain chemicals in the blood. When patients require long-term hemodialysis, doctors need a method to connect the patient to the dialysis machine to allow the blood to be filtered. An arteriovenous (AV) fistula is often the preferred method for this connection.
What is Dialysis & Why is a Fistula Needed?
There are two primary types of dialysis: peritoneal and hemodialysis. Peritoneal dialysis involves a surgically placed tube in the abdomen, through which dialysis fluids are introduced, allowed to dwell, and then drained, removing waste products. Hemodialysis, on the other hand, removes blood through a needle, cleanses it by passing it through a dialysis machine, and then returns the purified blood to the body via a second needle.
Frequent treatments require reliable blood access. Since most people need dialysis a few times per week, repeated needle punctures can be very hard on the veins and arteries. An AV fistula for dialysis creates a strong, reliable access point for these frequent treatments. It helps protect your veins from collapsing during repeated treatments. Arteries carry blood at high pressure away from the heart into every part of the body, while veins collect blood and carry it at low pressure back to the heart.
Steps for Creating a Fistula
To prepare for long-term dialysis, a reliable access point is crucial. Attaching the artery to the vein causes the vein to balloon out as high-pressure blood flows directly into it from the artery. About six weeks after this operation, the vein grows tougher and thicker. The stronger vein can better handle the needles needed for dialysis, making the process smoother and safer.
When your nephrologist (kidney doctor) determines that dialysis will be necessary in the near future based on multiple factors, such as lab values, they will recommend having the fistula or graft procedure. This is because the fistula can take up to six weeks to mature – meaning it takes that amount of time for the vein to become larger and thicker and be ready for dialysis.
During your initial consultation, you will have an ultrasound of both arms that maps your veins, determining a suitable vein to use for your fistula. Using a larger vein increases the chance of success. We generally prefer to use the nondominant arm for your fistula so that during dialysis sessions, patients can use the dominant arm for activity.
When the AV graft is implanted, two small incisions are made in the forearm (they can also be placed in the upper arm or the thigh if necessary). A tunnel is made under the skin to aid in graft placement. One end of the graft is sewn to the artery and the other to the vein. Blood will then flow rapidly from the artery through the graft into the vein.
The fistula will be completely under the skin and ready to use on the first day of dialysis. This strategy avoids having to place a temporary dialysis catheter, which has a high risk of infection, failure, and scarring of the patient’s large veins.
A board-certified vascular surgeon with experience creating fistulas is the best physician to perform the procedure.
Recognizing and Managing Complications
Once the fistula is placed, it is important to monitor for any complications. Here are a few to be aware of, although they are rare:
If you have any of these complications, it is important to speak to your doctor as soon as possible, as it can indicate an infection or malfunction of your fistula or graft. Early detection and treatment can help preserve the function of your fistula or graft and prevent more serious health issues.
Why Choose Empire Vein and Vascular Specialists?
If you need a fistula for dialysis, our board-certified vascular surgeons have extensive expertise in creating fistulas and are the best physicians to perform this type of procedure. We offer state-of-the-art vascular surgery services, including minimally invasive techniques, to ensure optimal outcomes for our patients. With 1,157 fistula creations and 523 AV grafts completed to date, our vascular team at Empire Vein and Vascular Specialists stands as the region’s leading experts in dialysis access care.
Also, we play a critical role in maintaining dialysis access. Occasionally, the veins in the arm can become narrowed, which can lead to arm swelling, inadequate dialysis, and prolonged bleeding after dialysis. To address this, we perform minimally invasive fistulograms on an outpatient basis. During this procedure, we can use angioplasty or a stent to treat blockages, keeping dialysis going with minimal interruption.
Schedule a Consultation Today for expert dialysis access care.