Av fistulas are surgically created channels between the artery and the vein for dialysis, and a vascular specialist creates it. Typically AV fistula is created in your arm, and if necessary, it can also be created in the leg.

The purpose of the AV fistula is to get the blood flow directly from the artery into the vein. It increases the pressure and quantity of blood flow in your vein, and increased pressure enlarges the veins.

The enlarged veins can provide sufficient blood flow to perform hemodialysis treatment. Dialysis is a process of removing wastes from your blood when the kidneys fail to perform this function.

The AV fistula allows the impure blood to flow into the dialysis machine; it is filtered there and flows back into your body.

AV fistulas are the best vascular access for long-term dialysis procedures because they can last longer compared to other dialysis access types. Av fistulas are less prone to infections and blood clotting, and performance is also outstanding.

Why AV fistula surgery is performed?

A doctor recommends AV fistula surgery for a complete dialysis procedure in case of end-stage kidney failure. If your kidney fails to perform its natural process of excreting toxic wastes out of your body, the wastes build up in your body causes life-threatening conditions. In this dialysis procedure, a machine is connected externally to filter wastes from the blood.

People suffering from chronic kidney diseases might require these dialysis procedures permanently or for a short time. Kidney failure due to drug overdose, shock, or a kidney infection happens suddenly, and they can be reversed with rapid treatment.

AV fistula surgery benefits patients who require long-term dialysis or people who are waiting for kidney transplantation. AV fistula surgery might be necessary for kidney failure due to:

• Kidney cancer
• Autoimmune diseases such as systemic lupus erythematosus
• Inherited disorders such as polycystic kidney disease
• Specific conditions which reduce the blood flow to your kidneys such as shock and renal artery stenosis
• Kidney inflammation diseases like nephritis and glomerulonephritis
  Other infections which include bladder infections, pyelonephritis, or septicemia
• Using specific medication or drug abuse, drug overdose, or long-term usage of NSAIDs that causes kidney problems
• Improper treatment or untreated chronic diseases like diabetes and high blood pressure can damage kidney over time
• Trauma or injuries to the kidneys or damage of blood supplying arteries to the kidneys
• Urinary tract problems such as kidney stones, tumours, and enlarged prostate glands

Congenital disabilities of specific organs can also damage your kidneys; a doctor explains all the treatment options before deciding on AV fistula surgery.

Who performs AV fistula surgery?

AV fistula surgery is performed by a general surgeon or vascular surgeon. A general surgeon who specialized in performing a wide variety of surgical treatments for various diseases, disorders, and conditions often performs this procedure.

A vascular surgeon who specialized in performing surgery to the faulty or damaged blood vessels also performs this surgery.

How is an AV fistula used in the dialysis process?

The dialysis machine is connected to the AV fistula. It is an outpatient procedure. The dialysis treatment procedure involves inserting two needles into your AV fistula, where one needle sends the blood to the externally connected dialysis machine for filtration.

The second needle sends the blood back into the body safely. Each dialysis session takes around four hours, and usually, patients require 3 sessions a week.

Benefits of an AV fistula

• Longer functional process compared to other forms of vascular access
• No artificial elements implanted in your body
• Provides sufficient blood flow required for efficient dialysis, which reduces the treatment time
• Lower risk of infections
• Less vulnerable to clotting compared to other dialysis access points
• Quick and safe outpatient procedure done under local anaesthesia
• You may return to your daily routine activities quickly

Non-functional dialysis fistulas

Sometimes, even the best possible care is taken, there are times where an AV fistula fails, often termed as non-functional dialysis fistula. This can be disappointing for the patient. Fortunately, various treatment options are available to fix malfunctioning or completely failed AV fistula.

The non-functional fistula can be fixed, and you can continue your dialysis treatments, as usual, and you can live healthily. If you can’t fix the fistula quickly, temporary access can be created so that you still able to receive dialysis until your fistula functions again.

An AV fistula fails if any of the vessels connected with the fistula become narrow and often called stenosis. When the blood vessel narrowed, the volume of blood flow reduces, and may not provide sufficient blood for dialysis.

An AV fistula also fails when a blood clot formed in the blood vessels and blocks the blood flow. It can also prevent dialysis procedure altogether with the AV fistula.

Depending on the situation of AV Fistula various treatment options suggested and among angioplasty with or without stenting for fistula failure is the best chosen by radiologists.

Balloon Angioplasty

If a fistula has a narrowing or blockage in the vessel, balloon angioplasty is one of the effective procedure used to unblock the vessels and restore blood flow.

Procedure

• A small needle prick is made near the arm to access the artery and a thin tube called a catheter is sent through it.
• The catheter is gently pushed into your blood vessel under the guidance of x-ray imaging technique.
• Once the catheter reaches the area of blockage, it is set in position and a small balloon is placed at the catheter end and is inflated.
• The inflated balloon opens up the narrowed vessel to restore blood flow.
• After the blocked area of the vessel is widened, the balloon will be deflated and withdrawn.

Dr. Pradyumna Reddy, an interventional specialist in Hyderabad, he is highly skilled in creating and managing dialysis access points. He can perform the AV fistula creation and help you manage the fistula while you are on dialysis.