Everything You Need to Know About AV Fistula Surgery

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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

It typically takes 1.5 to 2 hours.

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.

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.

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.

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

Yes, you can shower after AV fistula surgery.

It looks like a bulging vein under the skin surface.

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

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

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

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.

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