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DR. CHETAN PRAJAPATI ( M.S. | M.Ch. PLASTIC SURGERY)
PH: 9924084100 Email:drchetanmch@gmail.com

ARTERIO VENOUS FISTULA (AV FISTULA)

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Arterio venous fistula ( AV Fistula) in Ahmedabad,Gujarat.

A fistula (plural = fistulae) is made by a small operation to join an artery to a vein.

The blood vessels of the arm are chosen, either at the wrist or the elbow. The blood from the artery goes straight into the vein, which then becomes bigger and firmer. This means that it is possible to put two needles into the enlarged vein so that blood can be taken out of the body, sent through the dialysis machine and then returned through the second needle.

Health care providers recommend an AV fistula over the other types of access because it:

  1. provides good blood flow for dialysis
  2. lasts longer than other types of access
  3. It is less likely to get infected or cause blood clots than other types of access
  4. It has a lower tendency to clot
  5. It stays functional longer than other access types
  6. It’s usually less expensive to maintain

Who is a good candidate for this Procedure?

Patients choose rhinoplasty for their own personal reasons that often include:

  1. Person who recommended for dialysis, an AV fistula is the ideal vascular access for the patient.
  2. Sometimes dialysis is only needed tempAakarrily, but some people need it for the rest of their lives or until a kidney is available for a transplant.
  3. When kidney failure is diagnosed, time is needed to prepare the patient's body with an AV fistula

Procedure of AV Fistula

Blood flows in the arteries at high pressures and in the veins at low pressures. Commonly, it is the veins that are punctured for collection of blood samples etc.

Similarly, it is the veins that are punctured for doing hemodialysis. However, the veins as they are in a normal person, are too thin and fragile to be used for this purpose.

Besides, a high velocity blood flow to the tune of 300 to 500 mL/min is required for effective dialysis. Such a flow and pressure is present in the arteries. However, it is too unsafe to puncture arteries on a regular basis for obvious reasons !

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Therefore, the artery and the vein are surgically joined together, so that the pressure and high velocity flows of the artery are transmitted to the vein. The vein now swells up and has big enough lumen for a big dialysis needle and blood flowing at the required pressure and velocity.

The commonest site for this surgery is at the wrist, followed by the elbow. Left wrist ( Right in case of left-handers) is preferred, but the other side can be used if surgery fails on one side.

Veins from an AV Fistula are ready for use only after a minimum of 4 weeks.

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Test and Diagnosis

To diagnose an arteriovenous(AV) fistula, your doctor will ask you some tests like:

  1. Duplex ultrasound - Duplex ultrasound is the most effective and common way to check for an arteriovenous fistula in the blood vessels of your legs or arms. In duplex ultrasound, an instrument called a transducer is pressed against your skin over the suspicious area.
  2. Computerized tomography (CT) angiogram - A CT angiogram allows your doctor to check your arteries to see if blood flow is bypassing the capillaries. You'll receive an injection of a dye that shows up on CT images, and the doughnut-shaped CT scanner will be moved to take images of the artery your doctor believes is narrowed.
  3. Magnetic resonance angiography (MRA) - Your doctor may use an MRA if he or she thinks you may have an arteriovenous fistula in an artery that's deep under your skin. This test allows your doctor to see the soft tissues in your body. It uses the same technique as magnetic resonance imaging (MRI), but also includes the use of a special dye that helps create images of your blood vessels.

Care of AV Fistula

An AV fistula must mature for several weeks or months before it can be used for hemodialysis, so after it is surgically created, your doctor will ask you to work on strengthening it.The more access arm exercises you do to help strengthen it, the sooner you’ll be able to use your fistula.

The exercises your doctor recommends will depend on where your fistula is located. Fistulas are usually located in the forearm or upper arm. Before you start any exercise, it’s important to consult your doctor

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Once your AV fistula is strong enough to be used for hemodialysis, it is crucial that you keep it clean. Although a fistula is less prone to infection than other dialysis types, proper hygiene is still important:

  1. Look for redness or swelling around the fistula area.
  2. If you experience any pain in the fistula area, tell your doctor immediately.
  3. If you get a fever, this can be a sign of infection.
  4. Wash and pat dry your fistula arm thoroughly right before each treatment. Your dialysis facility will provide you with supplies.

Important tips to take care of the fistula

  1. Wash the fistula and keep it clean before dialysis. Do not scratch the fistula area and check blood flow for bruit sound
  2. If you experience redness, swelling, fever, or pain, notify your medical professionals immediately.
  3. Avoid repeated needle insertion at the same site
  4. Apply a cold compress (icepack) to the fistula within 24 hours after dialysis. After 24 hours, apply a hot compress to the fistula and do hand grasp exercises. In case hematoma occurs due to the disruption of the blood vessel, continue to apply cold compress to the fistula even after 24 hours. (Do not apply any unknown medicine on the fistula.) Precaution should be taken when applying a hot compress to avoid excessive heat and burns. When you feel it is too cold, stop the cold compress therapy.
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  5. The fistula can only be used for the purpose of dialysis. Do not have blood pressure taken from the fistula arm or perform venipuncture on it.
  6. Do not have your blood pressure taken from the fistula arm﹐or sleep on it. Do not wear tight straps, bracelets, or watches that will restrict blood flow to your arm.
  7. Do not have too much weight gain before dialysis (usually no more than 2 to 3 kilograms). When you experience low blood pressure or feel dizzy after dialysis, lie flat to prevent clotting in the fistula.
  8. Apply some pressure on the arm to stop bleeding after the needle is withdrawn and make sure that the blood still flows through the fistula.
  9. Do quit smoking as it is harmful to the fistula. Blood pressure and sugar also need to be well-controlled.
  10. When you do not feel the motion of blood flowing through the artificial vein or A-V fistula, it may indicate a clot in the fistula. Please consult Aakar Plastic and COSMETIC Clinic Ahmedabad,Gujarat. Our best plastic surgeon Dr. Chetan will take care of the problem.

Risks

The most frequent complications in Arteriovenous fistula (AV Fistula) site where needles are inserted. This can include infection around the access area or the formation of clots in the fistula.

Frequently Asked Questions

Our best plastic surgeons/AV fistula surgeon can create an AV fistula in your wrist, forearm, inner elbow or upper arm. When properly constructed, and with satisfactory maturation, an AV fistula can function for many years.

Unfortunately not every patient is suitable for an AV fistula. Numerous needle sticks for IV fluids, blood work and/or medicines can damage veins over time, creating scar tissue, which can make creation of an AV fistula impossible.

If the veins are damaged or too small, the AV fistula will not mature, or worse yet, clot. In this situation, the dialysis access team recommends other options that may include another fistula at a different site, catheter placement or an arteriovenous graft.

When you have kidney failure your body cannot get rid of waste products and excess fluid. Instead, these build up in the blood. Hemodialysis is one way to clean and filter the blood. It uses an artificial kidney, called a dialyzer. During treatment, the dialyzer filters the blood and clean blood is returned to your body.

AV fistulas last longer and need fewer repairs because a person's own vein is used. They also have lower rates of infection and hospital stays. Talk to your kidney doctor about an AV fistula. Ask for it as your first choice of vascular access for hemodialysis.

For more information you can consult our best plastic surgeon in Ahmedabad-Gujarat at our clinic the Aakar Plastic and COSMETIC Center. You can also call us at 9924084100 in Ahmedabad, gujarat and (+91)9924084100 from India.


Contact Details

Aakar-COSMETIC and Plastic Surgery,
SF-16, Palladium Complex,
OPP. 4D Square Mall,
Visat-Gandhinagar Highway,
Chandkheda, Ahmedabad-380005
Gujarat, India.

Contact To

  • Monday-Saturday: 9am to 8pm
  • Sunday: Closed