What is arteriovenous (AV) fistula surgery?

Arteriovenous (AV) fistula surgery creates a place to access the body’s circulatory system to perform dialysis. Dialysis removes wastes and extra fluid from the blood when the kidneys can no longer perform this function. This is known as kidney failure. An AV fistula allows blood to flow from your body to the dialysis machine and back into your body after filtering.

AV fistula surgery involves sewing together an artery and a vein, usually in the wrist or elbow area. This creates a larger, tougher vein that can tolerate multiple needle punctures that are needed for dialysis. You can see the thickened vein and feel a pulse in it after the AV fistula heals over several months.

AV fistula surgery is only one dialysis access option. It may not be the best option for everyone, such as people with small blood vessels. Other options include an AV graft (an artificial blood vessel) and a venous catheter, which is for short-term dialysis. AV fistula surgery is generally for people who need long-term dialysis and have healthy blood vessels. 

Consider getting a second opinion about all your dialysis access choices before having AV fistula surgery.

Why is arteriovenous (AV) fistula surgery performed?

Your doctor may recommend arteriovenous (AV) fistula surgery as part of a complete dialysis treatment plan for kidney failure. Kidney failure is a life-threatening condition. It causes a buildup of waste and fluid in the body due to poor kidney function. Dialysis uses a machine to filter wastes and extra fluid from the blood.  

People with kidney failure may require dialysis permanently or for a short time. Sometimes, kidney failure that occurs suddenly (acute kidney failure) can be reversed by rapidly treating the cause. Reversible causes can include a drug overdose, shock, or a kidney infection. 

AV fistula surgery is used for long-term dialysis for permanent or chronic kidney damage. People who have AV fistula surgery may be waiting for a kidney transplant. AV fistula surgery may be needed for kidney failure that results from:

  • Autoimmune diseases including systemic lupus erythematosus that affects the kidneys
  • Certain inherited diseases including polycystic kidney disease, which causes large cysts in the kidneys that damage kidney tissue
  • Conditions that reduce blood flow to the kidneys including shock and renal artery stenosis (narrowing of the renal arteries) 
  • Diseases that cause kidney inflammation including nephritis and glomerulonephritis
  • Infections including repeated bladder infection, pyelonephritis (kidney infection), or septicemia (blood infection)
  • Kidney cancer
  • Medication use or abuse including intravenous (IV) drug abuse, overdose of certain drugs, or long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Poorly treated or untreated chronic diseases including diabetes and high blood pressure that cause kidney damage over time
  • Trauma including injuries to the kidneys or arteries that supply blood to the kidneys
  • Urinary tract obstructions including kidney stones, tumors, congenital deformities, and enlarged prostate glands

Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on AV fistula surgery.

Who performs arteriovenous (AV) fistula surgery?

A general surgeon or vascular surgeon performs arteriovenous (AV) fistula surgery. A general surgeon specializes in the surgical treatment of a wide variety of diseases, disorders and conditions. A vascular surgeon specializes in surgery of the blood vessels.

How is arteriovenous (AV) fistula surgery performed?

Your arteriovenous (AV) fistula surgery will be performed in a hospital or outpatient surgery center. Surgeons usually create AV fistulas on the inner or palm side of the wrist or elbow. 

Your surgical team will clean the surgical site and start anesthesia. Your surgeon will make an incision and attach an artery to a vein with stitches. Your surgeon will restore blood flow through the blood vessels once they are completely connected and close the incision with stitches. The AV fistula will become larger and tougher as it heals over several months.  It will tolerate multiple needle punctures that are needed for dial