Arteriovenous Fistula for Hemodialysis
An arteriovenous fistula (AV fistula) is a connection created between an artery and a vein. People with end-stage kidney disease often need an AV fistula in their arm as a way to provide access for hemodialysis.
Why Choose U of U Health for Treatment?
Each year, our fellowship-trained, board-certified vascular surgeons at University of Utah Health perform nearly 500 AV fistula procedures for dialysis access. Our team can schedule the comprehensive evaluation and surgery to create an AV fistula over two consecutive days.
This convenient option means that patients who must travel a long distance only have to make one trip to U of U Health for this surgery. We offer on-campus housing at reasonable rates, and our team can recommend other options as well.
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What Is an Arteriovenous Fistula for Hemodialysis?
When people have kidney failure, their kidneys are no longer able to remove enough toxins from the blood to stay healthy. They need dialysis, a procedure that filters the blood and returns cleaned blood to the body. Dialysis can be temporary or long term. Many people on dialysis are waiting for a kidney transplant.
The most common form of dialysis is called hemodialysis, which uses an artificial kidney machine (dialyzer). During a hemodialysis session, blood from an artery (usually in your arm) flows through a plastic tube to the dialyzer, which filters the blood. The cleaned blood flows back into the body through a second tube that’s connected to a vein in the patient’s same arm. Most people on hemodialysis have the procedure three times a week.
For hemodialysis to happen, the care team needs a reliable, safe, and easy way to access your arteries and veins. This access point must be very strong to withstand dialysis treatment several times a week without collapsing. Your kidney specialist can recommend one of three options to create this access point:
- Arteriovenous fistula—an access site that a vascular surgeon creates by joining an artery and vein in your arm.
- Arteriovenous graft—a synthetic tube that the surgeon implants to join the artery and vein in your arm.
- Tunneled dialysis catheter—a tube placed from the surface of the skin into a large vein, usually in the neck.
An arteriovenous fistula is considered the safest, most reliable option. Compared to a catheter or graft, an arteriovenous fistula generally lasts longer and leads to fewer problems, such as clotting and infections.
When to Consider Getting an Arteriovenous Fistula
If you have surgery to create an AV fistula, the vein will grow wider and thicker, which will allow it to be accessed safely and blood to flow quickly during dialysis. Doctors refer to this as the “maturing” process, and it usually takes six to eight weeks. If problems arise, it could take even longer.
The AV fistula must mature fully before being used during dialysis. Therefore, it’s best to have the AV fistula surgery before you are in the last stage of kidney failure.
Before Your Surgery
People who are having surgery to create an arteriovenous fistula must have an evaluation with a vascular surgery provider beforehand. We typically schedule these appointments for Tuesday mornings at U of U Health Cardiovascular Center. However, appointments may also be available at Farmington Health Center and South Jordan Health Center.
The evaluation includes:
- an ultrasound test called artery and vein mapping to evaluate the size and quality of the arteries and veins in your arm,
- a physical exam to assess your overall health, and
- a conversation with the vascular surgery provider about the surgery.
Artery and vein mapping takes place on the day of your evaluation at a U of U Health vascular lab. Our scheduling team can help you make this appointment.
Arteriovenous Fistula Surgery
The arteriovenous fistula surgery can take place the day after your evaluation (typically a Wednesday) or at a later time, depending on your preference.
During the evaluation, the care team provides you with information about how to prepare for your surgery. Arteriovenous fistula surgery is an outpatient procedure, and an overnight stay at the hospital is rarely needed.
You will receive either local or general anesthesia for the surgery. The surgeon accesses the artery and vein through a small incision in your arm. The operation takes about an hour. Afterward, you’ll rest for one to two hours so the care team can watch you closely before discharging you. If you had general anesthesia, someone else needs to drive you home.
The incision site should heal within one to two weeks. Be sure to watch for signs of infection, such as pain, redness, swelling, or fever.
Following Up after Arteriovenous Fistula Surgery
Before using the AV fistula, a vascular surgery provider will need to see you in the clinic to make sure that the AV fistula has matured. This appointment will usually happen four to six weeks after surgery. During this appointment ultrasound mapping test to assess the blood flow through the AV fistula and decide whether it is ready to be used for dialysis. Most patients will be able to use their new fistula after it matures in six to eight weeks.
If the AV fistula does not mature properly, the vascular surgeon may recommend another type of procedure or consider using a graft instead.
Once you begin hemodialysis, your dialysis care team lets us know if any problems arise with your AV fistula. Problems may include low blood flow through the fistula, blood clots, or infection. You may need to return to U of U Health for another evaluation or surgery to keep the fistula working properly.
Taking Care of your Arteriovenous Fistula
The care team teaches you how to protect your AV fistula. The following are some key things to remember to avoid any complications after your procedure:
- Keep the AV fistula area clean at all times.
- Be careful not to bump or injure the area.
- Watch for signs of infection.
- Don’t sleep with the access arm under your head or body.
- Don’t carry heavy objects on your fistula arm.
- Don’t wear tight sleeves or jewelry on the access arm.
- Don’t allow blood pressures to be taken on your fistula arm.
If you notice any problems or have concerns, contact your vascular surgeon’s office right away.
Next Steps
To make an appointment at the University of Utah Health’s Arteriovenous Fistula Clinic, call 801-581-3495. If you would like to have the evaluation and surgery on two consecutive days, be sure to let the scheduler know.
