Overview
An arteriovenous fistula (AVF) connects an artery to a vein to create durable vascular access for haemodialysis. Dr. Ayubi provides both straightforward fistula creation and complex access procedures for CKD patients, including revision of poorly functioning or previously failed access.
Common Causes
Patients with advanced chronic kidney disease may need haemodialysis when the kidneys can no longer remove waste and excess fluid effectively. An AVF is often preferred for long-term dialysis because it uses the patient's own blood vessels and can provide dependable access when it matures successfully.
Signs & Symptoms
- Weak or absent vibration over an existing fistula
- Difficulty achieving adequate flow during dialysis
- Arm or hand swelling around the access
- Pain, numbness, coolness, or colour change in the hand
- Prolonged bleeding after dialysis needle removal
- Redness, warmth, discharge, or other signs of infection
When to Consult a Specialist
- Dialysis is expected to begin in the coming months
- A previous fistula has failed or is not maturing
- Dialysis staff report reduced access flow
- There is swelling, pain, bleeding, or suspected infection
- Complex vessel anatomy requires an alternative access plan
Diagnosis
- Clinical examination of arteries and veins in both arms
- Duplex ultrasound vessel mapping
- Review of previous dialysis access and procedures
- Assessment of circulation to the hand
- Additional vascular imaging for complex or repeat access
Treatment Options
- Radiocephalic or brachiocephalic AV fistula creation
- Brachiobasilic fistula with vein transposition
- Complex AVF creation when standard vessels are unsuitable
- Revision or salvage of a non-maturing fistula
- Management of narrowing, thrombosis, aneurysm, or steal symptoms
Procedure Information
After vessel mapping, a suitable artery and vein are selected and joined surgically. The access is then allowed time to mature before routine dialysis use. Complex procedures may involve vein transposition, revision of an existing fistula, or an individualized approach based on previous access and vessel quality.
Benefits & Possible Risks
Benefits
- Durable access for long-term haemodialysis
- Lower infection risk than many catheter-based options
- Uses the patient's own blood vessels where possible
- Supports reliable blood flow during dialysis
- Individualized options for complex or repeat access
Possible Risks
Possible risks include bleeding, infection, failure to mature, narrowing, thrombosis, aneurysm formation, arm swelling, reduced circulation to the hand, or the need for another procedure. Individual risks depend on vessel quality, diabetes, prior access, and overall health.
Recovery & Follow-Up
- Keep the incision clean and follow wound-care instructions
- Avoid pressure, tight clothing, and blood tests on the access arm
- Check the fistula vibration regularly as advised
- Attend follow-up to assess healing and maturation
- Begin dialysis use only after the access is declared ready