Patients who have kidney disease or kidney failure who need to have dialysis treatment will need vascular access created in order to allow the blood to be processed quickly. The optimal type of vascular access is known as an arterio-venous fistula or AV fistula (see more on access methods here).
Ideally an AV fistula needs to be created 2-4 months before it can be used, to allow it to heal and to develop to a point where it will allow faster blood treatment (a process referred to as 'maturing'), and they can take up to 3-6 months to mature fully.
The AV fistula is generally created in the lower arm, but can also be located in the upper arm or upper leg. Placement of the fistula is decided by Dr Hagley based on your medical history related to arterial and venous disease and he may need to perform an ultrasound blood flow or blood vessel mapping test to decide if your veins are suitable for a fistula (no anaesthetic is needed for this test). If they are not, an alternative, such as a graft may be recommended instead.
The procedure to create an AV fistula is normally performed under local anaesthetic. It is performed in the hospital operating theatre and takes around 60 minutes to complete. You are generally able to return home the next day.
Before surgery you will need to fast, that is not eat or drink anything in the 6 hours before surgery and you may need to stop (or reduce) any medications that may heighten the risk of bleeding or other potential complications.
After surgery, you will need to keep the incision dry and covered for 2-3 days and it is a good idea to keep the arm raised (for example on some pillows or cushions) when sitting or sleeping to minimise any swelling and pain. There will be a “thrill’ or “buzz” you can feel over the fistula. This is normal and is an indication that the blood is flowing quickly through the new AV fistula.
Dr Hagley will be able to give you more specific advice on how to prepare for surgery and what you will need to do after surgery.