Arteriovenous (AV) Fistula Surgery


Catherine Spader, RN

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 dialysis.

Types of anesthesia that may be used

Surgeons often perform AV fistula surgery using local anesthesia while the patient is sedated. Local anesthesia involves injecting an anesthetic in the skin and tissues around the surgery area to numb the area. You may have another form of anesthesia, depending on your condition: 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your AV fistula surgery

The day of your AV fistula surgery, you can generally expect:

  • To talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form. It is important to verify the correct surgical site with the operating staff.

  • To remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • To talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and all vital signs are stable.

What are the risks and potential complications of arteriovenous (AV) fistula surgery?

As with all surgeries, arteriovenous (AV) fistula surgery involves risks and potential complications. An A