Arteriovenous fistula

Introduction to Procedure

We know that undergoing any procedure is a scary experience. We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd. We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.

Description of procedure

Arteriovenous fistulas are fashioned to provide a high-flow vessel that is easily accessible for haemodialysis in patients with chronic renal failure. Superficial veins from the upper limb such as the cephalic and basilica vein can be anastomosed to adjacent arteries. The fistula must then mature over the following 4 – 6 weeks before it can be used for dialysis.

Operative techniques

Venous anatomy may be determined preoperatively using duplex ultrasound. The site should be marked preoperatively. An appropriate incision is made that allows access to both the vein and artery. The vein is dissected and mobilised towards the artery. The vessels are anastomosed with non-absorbable sutures.

Additional procedures that may become necessary

It may be impossible to form a fistula due to the unsuitability of the vein.
A synthetic graft could be an alternative conduit in this situation.

Alternative procedures/conservative measures

Central venous catheters may be used.
Synthetic grafts are an alternative when no suitable vein is available.
Peritoneal dialysis may also be considered.
Renal transplant.
Patients not suitable for dialysis or renal transplant may be managed.

Serious/frequently occurring risks

Bleeding, thrombosis, infection, steal syndrome, aneurysm formation, venous hypertension.

Blood transfusion necessary

None.

Type of anaesthesia/sedation

General anaesthesia.
Epidural anaesthesia before surgery may help reduce the likelihood of phantom limb pain.

Follow-up or need for further procedure

Fistula may fail due to technical complications and if detected early may be salvaged by prompt surgical intervention.
Exclude long-term complications that may require ligation of fistula, such as aneurysm formation or steal syndrome.