AV Fistula Surgery for Dialysis (2022)

Medically Reviewed By John A. Moawad, MD, FACS

— Written By Mandy Baker

Updated on May 23, 2022

AV fistula surgery creates a connection between your artery and your vein. The connection is later used for dialysis access. This article will explain what AV fistula surgery is, why it is needed, and how it is performed. It will also discuss the possible risks involved and what to expect after surgery.

What is AV fistula surgery?

AV Fistula Surgery for Dialysis (1)

An arteriovenous (AV) fistula is a surgery that is performed to connect a vein and an artery. This is typically done in your arm between the wrist and the elbow or in the upper arm.

Connecting the vein and the artery increases blood flow in the vein. This allows the joined vein to grow larger and thicker, becoming more like an artery. Your doctor may recommend this procedure if you have advanced chronic kidney disease (CKD) that requires long-term dialysis care.

Dialysis is a treatment that removes waste and excess fluids from your blood when your kidneys are unable to do so. It is typically used when someone develops end stage renal failure. This is usually when you have lost 80–90% of kidney function.

When your kidneys stop working the way they should and begin to fail, waste and fluid can build up in your body. Left untreated, this is potentially dangerous and sometimes fatal.

Dialysis helps to rebalance your body by:

  • helping to control your blood pressure
  • helping to keep safe levels of substances, such as potassium, sodium, and bicarbonate, in your blood
  • helping to remove waste, salt, and water to prevent them from building up in your body

AV fistula surgery is ideally done before dialysis treatment begins. It creates a blood vessel that is robust enough to withstand the regular needling involved with dialysis. If you need to begin dialysis before surgery, your doctor will need to place large tubes in the central veins of the neck for temporary dialysis.

(Video) Arteriovenous Fistula Creation - Brachiobasilic Transposition (Eric Peden, MD, M. Mujeeb Zubair, MD)

With most dialysis procedures, your blood is taken from your body and put through a machine to filter and clean it. It is then returned to your body. Your body can better process the high volumes of blood during dialysis after AV fistula surgery.

Visit our hub to learn more about kidney disease.

Before your surgery, your doctor may ask you to fast, or not eat or drink anything, for 8 hours beforehand. They may also state that you should not have any blood drawn or have an intravenous (IV) needle placed in that arm. This is to preserve your veins for the surgery.

You should always follow all the instructions given by your doctor before surgery.

The fistula created in surgery is typically done in your nondominant arm.

On the day of your surgery, there are different steps your surgical team will take before and during the procedure.

Assessment

Your surgeon will need to assess you and your veins before surgery.

This assessment will include:

  • an explanation of the procedure from your surgeon
  • a physical exam that focuses on the selected arm
  • an ultrasound scan to map out and assess the veins in your arm

Anesthetic

There are a few options for the type of anesthetic used during the procedure. Your doctor will discuss the options with you and formulate the best plan for your individual needs.

The possible types of anesthetic are:

  • Local anesthetic: This is a medication given by injection at the site where the surgeon will perform the procedure. This medication numbs the area. It is sometimes given alongside a sedation medication through an IV in your other arm.
  • Regional block: This type numbs the nerves in your entire arm.
  • General anesthetic: This is typically a sedation medication given through an IV. Sometimes it is a gas that is inhaled through a mask. This type of anesthetic puts you to sleep completely. Usually, your surgical team places a tube down your throat to help with breathing during surgery.

Procedure

These are the steps your surgeon and their team will typically take during the surgery:

  1. The surgical team cleans your arm with an antiseptic solution.
  2. They place sterile drapes around the procedure area.
  3. Your surgeon makes an incision between your artery and vein.
  4. Your surgeon will generally divide the vein and then connect one end to the artery.
  5. Your surgeon closes the incision.
  6. The surgical team places sterile dressings on the area.

What should you expect after AV fistula surgery?

(Video) THE MOUNT SINAI SURGICAL FILM ATLAS: Arteriovenous Fistula

After the surgery is complete, your doctor will give you aftercare instructions. To ensure your fistula works properly and to avoid infection, you should follow these instructions carefully.

The aftercare instructions may include the following steps.

Keep it clean

You should keep the procedure area clean at all times.

Your doctor may ask you to:

  • Exercise your hand frequently by making a fist or using a squeeze ball or toy.
  • Gently wash the procedure area every day with antibacterial soap.
  • Wash the area thoroughly before each dialysis treatment.

Check it

You should check the area every day to keep an eye out for signs of infection.

These signs include:

  • pain
  • swelling
  • fever
  • flu-like symptoms
  • flushed appearance around the area

If you notice any of these signs of infection, contact your doctor.

Your doctor may instruct you to be careful with the area and to avoid doing certain things.

Some of the things you may need to avoid include:

  • putting pressure on the area
  • carrying anything heavy
  • wearing tight clothing or jewelry around the area
  • sleeping on your arm
  • scratching the procedure area

Your doctor will also most likely instruct you to use your other arm for any medical tests. These include blood draws and blood pressure checks.

Read about the stages of chronic kidney disease here.

What are the risks of AV fistula surgery?

With any surgery, there are possible risks, such as infection.

The risks for AV fistula surgery include:

  • Clotting: If a clot forms in your fistula, this can stop blood flow. If you notice any changes, you should contact your doctor immediately. It is possible that the clot can be removed.
  • Steal syndrome: If too much blood flows from your artery to your vein, it can decrease blood flow to your hand, causing coldness and numbness. In some cases, it can decrease blood flow to the nerves, which affects hand strength. This typically happens in less than 10% of cases of steal syndrome. If you develop symptoms of steal syndrome, contact your doctor immediately.
  • Numbness in the thumb: Occasionally, AV fistula surgery can bruise a nerve. This often leads to a feeling of numbness in your thumb. It tends to recover on its own over the course of a few weeks.

If you have any questions or concerns, contact your doctor.

Frequently asked questions

(Video) What is an AV fistula for Dialysis and how long do they last?

Here are some other questions people have asked about AV fistula surgery. These questions have all been answered by Dr. John Moawad, M.D.

How long does AV fistula surgery take?

It typically takes 1.5 to 2 hours.

How long does it take to recover from AV fistula surgery?

You are typically able to go home about 2 hours after the procedure. If you have a nerve block, the function of your hand will not return until the next day. After regaining function in your hand, you should start using your hand right away. There is typically no need to rest it.

Is AV fistula surgery high risk?

Generally, if your doctor can avoid using a general anesthetic, then it is not considered high risk. However, there can still be complications since most of these patients already have many risk factors.

What happens after AV fistula surgery?

Pain medications are typically only needed for a couple of days. Over a period of 2–4 months, the fistula will undergo a process called maturation. This is where the connected vein will enlarge and thicken to handle the necessary dialysis flow.

You will have pain afterward, but generally, pain medications are only needed for a couple of days.

Are you put to sleep for AV fistula surgery?

(Video) Vascular access ⭐️(Arteriovenous fistula)

Most of the time only local anesthetic, sedation, or a nerve block are necessary.

Can you shower after AV fistula surgery?

Yes, you can shower after AV fistula surgery.

How does a fistula look in your arm?

It looks like a bulging vein under the skin surface.

Can you do a finger stick on an arm with a fistula?

No. Do not do a finger stick. As the blood flow is too vigorous, you may have difficulty stopping it on your own.

What is the most common complication of AV fistula?

The most common complication is the failure of the fistula to function or mature. This may require additional procedures.

How long can you live on dialysis?

While life span is reduced on dialysis, you can live many years with good care.

Summary

AV fistula surgery is a procedure where one of your veins is connected to an artery. This creates a more robust vessel for blood flow during dialysis.

(Video) Dialysis Access and Fistula Procedure

AV fistula surgery is typically performed on your nondominant arm before dialysis treatment begins.

FAQs

How long does a dialysis fistula surgery take? ›

Arteriovenous Fistula Surgery

You will receive either local or general anesthesia for the surgery. The surgeon accesses the artery and vein through a small incision in your arm. The operation takes about an hour. Afterward, you'll rest for one to two hours so the care team can watch you closely before discharging you.

How long does an AV fistula for dialysis last? ›

AV grafts can be safely used in about two weeks, as no maturation of the vessels is necessary. Grafts have a lifespan of approximately 2 to 3 years but can often last longer.

Is AV fistula a high risk surgery? ›

Objective. The creation of an arteriovenous fistula (AVF) for hemodialysis access is a low-risk procedure. It is often time sensitive, as avoidance of central venous catheters (CVCs) and their complications is paramount.

What happens after fistula surgery for dialysis? ›

It is normal to experience some pain and swelling over the next several days. For the first few days after your access surgery, keep your arm elevated on pillows whenever possible. Be sure to keep your arm above the level of your heart to control swelling and ease any discomfort you may be feeling.

How long is recovery after AV fistula surgery? ›

How long will my wound take to heal? Your wound will take 10-14 days to heal. We advise that the dressing stay dry for at least three days before being changed. You will be given several spare dressings.

How long is hospital stay for fistula surgery? ›

With a fistulotomy, a person will usually go home the same day. They may have some pain and drainage from the wound but should be able to return to work within a day or two.

Is fistula surgery painful? ›

You will likely have some pain and bleeding with bowel movements for the first 1 to 2 weeks. You can make your bowel movements less painful by getting enough fibre and fluids, and using stool softeners or laxatives. Sitting in warm water (sitz bath) after bowel movements will also help.

Is AV fistula placement a major surgery? ›

AV fistula surgery takes a few hours and is generally an outpatient procedure. It can be done under general anesthesia or through a numbing of the arm.

How much does AV fistula cost? ›

How Much Does a Creation of an Arteriovenous Fistula Cost? On MDsave, the cost of a Creation of an Arteriovenous Fistula ranges from $6,982 to $10,788. Those on high deductible health plans or without insurance can save when they buy their procedure upfront through MDsave.

Can you do dialysis without a fistula? ›

If you need immediate or emergency dialysis or cannot receive and don't have an AV fistula or graft, you will require a CVC.

What happens if AV fistula fails? ›

An AV fistula can fail when there is a narrowing, also called stenosis, in one of the vessels associated with the fistula. When a narrowing occurs, the volume and rate of blood flow can decrease, and you may be unable to dialyze adequately.

What is the most common complication of AV fistula? ›

Heart failure.

This is the most serious complication of large arteriovenous fistulas. Blood flows more quickly through an arteriovenous fistula than it does through typical blood vessels. The increased blood flow makes the heart pump harder. Over time, the strain on the heart can lead to heart failure.

Are you awake during fistula surgery? ›

We give you general anesthesia, meaning you will be asleep and not able to feel any sensation during your procedure. We cut open the fistula tract and remove diseased tissue or drain pus. This converts the fistula from a tunnel to an open groove and allows the fistula tract to heal from the inside out.

What are the restrictions after fistula surgery? ›

Don't lift anything that weighs more than 10 pounds with your access arm for the first 3 weeks. Don't push or pull with the access arm for the first 3 weeks. Never pick scabs near your graft or fistula needles sites. Don't keep your access arm bent for a long time.

How do you shower with a fistula? ›

If you have a graft or fistula, keep the dressing dry for the first 2 days. You can bathe or shower as usual after the dressing is removed. If you have a central venous catheter, you must keep the dressing dry at all times. Cover it with plastic when you shower.

How do I prepare for AV fistula? ›

The first step in AV fistula creation is to evaluate your blood vessels (veins and arteries), to ensure they are healthy enough to support a fistula. The first step in the evaluation will be a physical examination of your arms performed by your vascular specialist.

When can I go back to work after AV fistula surgery? ›

You may drive when your doctor says it is okay. This is usually in 1 to 2 days. Most people are able to return to work about 1 or 2 days after surgery.

Can you drive after AV fistula surgery? ›

Activity After Hemodialysis Fistula or Graft Access Surgery

Lifting may put a strain on the incision before it has had time to heal. Please avoid heavy physical exercise or exertion for two weeks. Please do not drive until you have stopped taking your prescription pain medication.

Can I walk after fistula surgery? ›

You may need rest for a few days after your operation, but you should avoid sitting still for a long time. Also avoid doing too much walking.

How serious is a fistula operation? ›

Like any type of treatment, treatment for anal fistulas carries a number of risks. The main risks are: infection – this may require a course of antibiotics; severe cases may need to be treated in hospital. recurrence of the fistula – the fistula can sometimes recur despite surgery.

What is the fastest way to recover from a fistula surgery? ›

Your Recovery

You will likely have some pain and bleeding with bowel movements for the first 1 to 2 weeks. You can make your bowel movements less painful by getting enough fiber and fluids. And you can use stool softeners or laxatives. Sitting in warm water (sitz bath) after bowel movements will also help.

How urgent is fistula surgery? ›

Fistulas require immediate medical attention to prevent serious infections or other problems from developing. Treatment options include medications, surgery, or both.

Is AV fistula temporary or permanent? ›

An AV fistula is a surgically-created permanent access located under the skin, making a direct connection between a vein and an artery. An AV fistula is typically created in the non-dominant arm. If the veins in your arm are not large or healthy enough to support a fistula, it may be created in your leg.

Can poop come out of fistula? ›

Bowel contents can leak through the fistula, allowing gas or stool to pass through your vagina.

How long can you live on dialysis? ›

Average life expectancy on dialysis is 5-10 years, however, many patients have lived well on dialysis for 20 or even 30 years. Talk to your healthcare team about how to take care of yourself and stay healthy on dialysis.

When should I get a fistula for dialysis? ›

The longer a fistula has to develop before it is used for dialysis the better it performs and the longer it lasts. It is therefore recommended that a fistula be created approximately six months before you need to start dialysis.

Why do dialysis patients need a fistula? ›

An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible.

Does Medicare cover fistula surgery? ›

Medicare won't cover surgery or other services needed to prepare for dialysis (like surgery for a blood access (fistula)) before Medicare coverage begins. However, if you complete home dialysis training, your Medicare coverage will start the month you begin regular dialysis, and these services could be covered.

How much does a dialysis fistula cost? ›

A common AV fistula creation for dialysis at surgery center facility in U.S. includes
UnitsAvg Cash price
Anesthesia
Anesthesiologist fee to be "put under" for procedure Level 3 Standard1$202
Anesthesiologist time to be "put under" for procedure Per minute Standard233$466
Total average cash price$3,400.60
5 more rows

What is the difference between an AV graft and a fistula? ›

a fistula, which is made by joining together an artery and vein to make a bigger high-flow blood vessel. a graft, in which a soft plastic tube is placed between an artery and a vein, creating an artificial high-flow blood vessel.

Can you shower with a dialysis port? ›

You can shower or bathe if you have a clear dressing that sticks to your catheter site and the skin around it. This type of dressing is recommended because it's water proof, which helps prevent infection.

What are the 3 types of dialysis? ›

There are 3 main types of dialysis: in-center hemodialysis, home hemodialysis, and peritoneal dialysis. Each type has pros and cons.

How do you know if AV fistula is working? ›

You need to look, listen and feel for signs that your AV fistula is functioning properly. Look – Look at your access to check for signs of infection – swelling, redness, warmth and drainage are all signs to watch for. Also note if there are any changes to the skin, such as bleeding, bulging or peeling.

Why AV fistula is done? ›

An AV fistula allows large amounts of blood to flow continuously to filter as much blood as possible at a go. An AV fistula should be created before the first treatment. An AV fistula is usually placed in the forearm or upper arm. This provides reliable access to the blood vessels.

What are the three types of fistula? ›

The three most common AVFs are the radiocephalic fistula, the brachiocephalic fistula, and the brachial artery–to–transposed basilic vein fistula.

How does AV fistula cause heart failure? ›

When a large proportion of arterial blood is shunted from the left-sided circulation to the right-sided circulation via the fistula, the increase in preload can lead to increased cardiac output. Over time, the demands of an increased workload may lead to cardiac hypertrophy and eventual heart failure.

How long does a dialysis treatment take? ›

Hemodialysis is most often done at a special dialysis center. You will have about 3 treatments a week. Treatment takes about 3 to 4 hours each time. You may feel tired for several hours after the dialysis.

How long before AV fistula matures? ›

How long does it take a fistula to mature before it can be used for dialysis? Arteriovenous fistulas can take between 6-12 weeks to mature and arteriovenous grafts can generally be used 2-3 weeks after surgery.

How do you prevent blood clots during dialysis? ›

Heparin is a type of medicine called a blood thinner. Heparin is used to prevent blood from clotting in the dialysis lines during hemodialysis.

What is the success rate of fistula surgery? ›

Living with a fistula can have a big impact on a person's quality of life. However, for most people, fistula surgery is successful, and recurrence rates are low. For example, the long-term success rate of a fistulotomy is 92–97%.

Which anesthesia is given for fistula surgery? ›

Background and objectives: Regional anesthesia has been proposed as the preferred mode of anesthesia for arteriovenous fistula surgery due to its associated vasodilatory effects and fistula patency rates.

Is renal dialysis painful? ›

The dialysis treatment itself is painless. However, some patients may have a drop in their blood pressure that could lead to nausea, vomiting, headaches or cramps. However, if you take care to follow your kidney diet and fluid restrictions these types of side effects can be avoided. Myth: Dialysis is a death sentence.

Is AV fistula surgery high risk? ›

The creation of an arteriovenous fistula (AVF) for hemodialysis access is a low-risk procedure. It is often time sensitive, as avoidance of central venous catheters (CVCs) and their complications is paramount.

How much time does AV fistula surgery take? ›

How is the AV fistula procedure performed? A surgeon usually performs the procedure in the operating room. You receive a local anesthetic (numbing medicine) at the proposed site along with IV sedation to relax you. Discomfort is minimal and you may even fall asleep during the 1 to 2 hour-long procedure.

What can I expect after dialysis fistula surgery? ›

It is normal to experience some pain and swelling over the next several days. For the first few days after your access surgery, keep your arm elevated on pillows whenever possible. Be sure to keep your arm above the level of your heart to control swelling and ease any discomfort you may be feeling.

Why does my dialysis fistula hurt? ›

This is usually caused by a needle coming out of the vessel into the tissue (called 'bumping') or by not pressing firmly when your needle is removed. Bruising and swelling can also occur if you move your arm around during dialysis, however bruising and swelling is much less likely to occur as the fistula matures.

Can you drive after hemodialysis? ›

If you drive before starting dialysis, then you can continue to do so once you have started treatment. When you first start dialysis, you may feel weak or a little unsteady after treatment. It is best to have someone pick you up after dialysis for the first week. After that, you may resume driving as you feel able.

Are you awake during fistula surgery? ›

We give you general anesthesia, meaning you will be asleep and not able to feel any sensation during your procedure. We cut open the fistula tract and remove diseased tissue or drain pus. This converts the fistula from a tunnel to an open groove and allows the fistula tract to heal from the inside out.

Is fistula surgery painful? ›

You will likely have some pain and bleeding with bowel movements for the first 1 to 2 weeks. You can make your bowel movements less painful by getting enough fibre and fluids, and using stool softeners or laxatives. Sitting in warm water (sitz bath) after bowel movements will also help.

Can I drive after fistula surgery? ›

Driving and other activities such as operating heavy machinery should be avoided for at least 48 hours after the surgery. Patients should be advised to avoid swimming until the wound has healed completely. Patients may feel some pain as well as bleeding from the wound when they go to the toilet.

Does having a fistula hurt? ›

Symptoms of an anal fistula

a constant, throbbing pain that may be worse when you sit down, move around, poo or cough. smelly discharge from near your anus. passing pus or blood when you poo. swelling and redness around your anus and a high temperature (fever) if you also have an abscess.

What is the most common complication of AV fistulas? ›

Heart failure.

This is the most serious complication of large arteriovenous fistulas. Blood flows more quickly through an arteriovenous fistula than it does through typical blood vessels. The increased blood flow makes the heart pump harder. Over time, the strain on the heart can lead to heart failure.

Can you do dialysis without a fistula? ›

If you need immediate or emergency dialysis or cannot receive and don't have an AV fistula or graft, you will require a CVC.

How much does AV fistula cost? ›

How Much Does a Creation of an Arteriovenous Fistula Cost? On MDsave, the cost of a Creation of an Arteriovenous Fistula ranges from $6,982 to $10,788. Those on high deductible health plans or without insurance can save when they buy their procedure upfront through MDsave.

How serious is a fistula operation? ›

Like any type of treatment, treatment for anal fistulas carries a number of risks. The main risks are: infection – this may require a course of antibiotics; severe cases may need to be treated in hospital. recurrence of the fistula – the fistula can sometimes recur despite surgery.

How successful is fistula surgery? ›

Living with a fistula can have a big impact on a person's quality of life. However, for most people, fistula surgery is successful, and recurrence rates are low. For example, the long-term success rate of a fistulotomy is 92–97%.

How urgent is fistula surgery? ›

Fistulas require immediate medical attention to prevent serious infections or other problems from developing. Treatment options include medications, surgery, or both.

Can you shower with an AV fistula? ›

If you have a graft or fistula, keep the dressing dry for the first 2 days. You can bathe or shower as usual after the dressing is removed. If you have a central venous catheter, you must keep the dressing dry at all times. Cover it with plastic when you shower.

What should avoid after fistula surgery? ›

Spicy foods: Avoid spicy as well as hot food items, which increases pain and bleeding during defecation. Caffeine: Avoid caffeine when having a fistula because it can lead to dehydration. Some food items include caffeine are coffee, tea, chocolates etc. Alcohol: This can also cause dehydration leading to hard stools.

What are the restrictions after fistula surgery? ›

Don't lift anything that weighs more than 10 pounds with your access arm for the first 3 weeks. Don't push or pull with the access arm for the first 3 weeks. Never pick scabs near your graft or fistula needles sites. Don't keep your access arm bent for a long time.

Do fistulas smell? ›

Symptoms of anal fistulas

You may experience pain with the pressure of bowel movements. You might bleed in between and during bowel movements. Other symptoms include: Bloody, foul-smelling pus that comes from an opening in your skin near your anus.

Why do dialysis fistulas get so big? ›

Over time, your fistula should get larger, extending past the lines drawn on your arm when your access was created. This allows more blood to flow through the fistula and into the vein in order to provide a high enough blood flow rate during your hemodialysis treatments.

How do you take care of AV fistula? ›

Daily care of AV fistula. Reduce risk of infection by washing hands with soap and water both before and after touching AV fistula. Keep skin around fistula clean by washing it with antibacterial soap often, especially before dialysis. Clean the fistula by washing and gently patting it dry.

Videos

1. Creation of Radiocephalic Fistula (Eric K. Peden, MD, M. Mujeeb Zubair, MD)
(Houston Methodist DeBakey CV Education)
2. Dialysis Fistula animation
(Jonathan Slater)
3. Brachiocephalic Arteriovenous Fistula - Dr. Christian DeVirgilio
(GIBLIB)
4. Physical Examination of Arteriovenous Fistula
(Atrium Health Wake Forest Baptist)
5. Dialysis Vascular Access Fistula Surgery Jeremy Crane
(Jeremy Crane)
6. What does a fistula for dialysis look like? [CHT CERTIFICATION REVIEW] 2022
(Utopia HCC)

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