Patients that are on, or plan to start, hemodialysis have better short- and long-term outcomes if they receive dialysis through a arteriovenous fistula. The word "fistula" means an abnormal or surgically created connection between two vessels. The creation of an arteriovenous fistula, in which an artery and vein are surgically connected to each other, takes place in an outpatient surgical setting. No foreign material is inserted into the patient. The connection of the artery and vein is below the skin, so nothing is extruding from the patient after surgery.
This operation does not require general anesthesia but rather is performed with the aid of a peripheral nerve block and sedation. The operation typically takes one hour, and patients go home from the recovery room after surgery.
Once the operation is complete, it takes an average of 6-8 weeks for the vein to grow or mature enough to be usable for hemodialysis.
For patients that do not have veins suitable for arteriovenous fistula creation, a graft can be placed between an artery and a large, deep vein in the arm. The graft is then accessed by the hemodialysis staff for dialysis. The operation to place an arteriovenous graft is also an outpatient procedure and does not require general anesthesia.
Patients should make sure they do not eat or drink anything after midnight the day before their surgery. For patients who take medications in the mornings, they may take them as directed with a small sip of water.
The word fistula means an abnormal connection. In this case, the connection is between an artery and a vein created by a surgeon. This will be used as the access point to receive dialysis.
An arteriovenous graft is a connection between an artery and a vein using a piece of artificial tubing that is attached on one end to an artery and on the other end to a vein. The tube is placed entirely under the skin. The graft (tube) may be synthetic or may be a transplanted animal or human blood vessel.
Fistulas can be created in many locations. We most often place them in the wrist, forearm, and upper arm.
Arteriovenous fistulas can take between 6-12 weeks to mature and arteriovenous grafts can generally be used 2-3 weeks after surgery.
It's important to perform forearm exercises with the aid of a stress ball. You should squeeze and release the ball rapidly for 10 minutes 6 times per day.
It is okay to shower immediately after surgery with the plastic dressing in place. You may also shower after the dressing has been removed (follow discharge instructions for removal). Do not soak in bathtubs/hot tubs/pools/lakes until cleared by your provider.
The outer dressing can be removed 48 hours after surgery. It is okay to cover the incision site again with a sterile gauze pad, or it can be left open to air.
Yes. You should be seen in the clinic 2-3 weeks after your surgery, where we will check your fistula and incision and remove any staples. Please call Kristin at 720-848-0833 to make your appointment.