Native Arteriovenous (AV) Fistula
In order to have haemodialysis treatment to remove waste products and excess fluid from your body, the medical team require access to your bloodstream. The native AV fistula is one type of vascular access that facilitates this treatment.
Prior to the procedure your consultant will discuss the vascular access options with you. They will also carry out an ultrasound scan of the veins in your arms, to choose the best place to create the fistula. In some cases, a venogram may be required, this is an x-ray that uses a contrast to show how blood flows through your veins.
What is a Native AV Fistula?
A native AV fistula is created by having a small operation. This involves joining your artery
(blood vessel that carries blood away from your heart) to your vein (blood vessel that carries blood back toward your heart) at the level of your wrist or at your elbow. This results in an increased (arterial) blood flow through the vein, which over time makes it become thicker and stronger. This means that dialysis needles can be inserted regularly and it makes it easier to transfer your blood to the dialysis machine and back again.
The procedure is normally carried out under local anaesthetic which means your skin will be numb. In some circumstances, general anaesthetic may be considered, which means you will be asleep during the surgery.
The operation normally takes one hour to complete. If you have had a local anaesthetic you should be able to go home later that day. If you have had a general anaesthetic, you will usually need to stay in hospital overnight. You should be able to return to normal activities within one to two weeks after the surgery.
Why should I have a Native AV Fistula?
The purpose of haemodialysis is to clean your blood, consequently you need to have an easily accessible site that allows dialysis needles to be inserted regularly. There is evidence that suggests this is the best type of vascular access as it is likely to last longer, you are likely to have fewer complications (for example infections), and it provides the highest blood flow for dialysis.
Are there any alternatives?
With 72% of patients requiring kidney replacement treatment starting on haemodialysis, they all require vascular access. Whilst native AV fistula is thought to be the best type of vascular access, this method may not be suitable for some people with small and weak veins. In this scenario an arteriovenous (AV) graft may be a better alternative.
How soon can my Native AV Fistula be used for haemodialysis?
You will need to wait for 6-8 weeks for the vein to enlarge enough for the haemodialysis needles to be inserted. If you require haemodialysis treatment before this, a haemodialysis line can be inserted into a neck vein as a temporary measure.
What are the risks?
As previously mentioned, the native AV fistula is the preferred choice of vascular access because there is less risk of developing problems. However, as with any procedure, problems can arise and you should be aware of them.
Potential risks include;
· Bleeding from the fistula site which may occasionally require a blood transfusion.
· Infection. Any wound site has a risk of developing an infection, this can be treated with antibiotics.
· Blocked fistula. If the fistula becomes blocked it may stop working, you can test this by placing your hand over the fistula and you should feel a buzzing sensation caused by the high flow of blood through the vein.
· Swelling in the fistula arm following surgery. It is important to move the arm as much as possible after surgery to prevent swelling and the arm becoming stiff.
· Reduced blood supply to the hand. This can happen if too much blood travels through the fistula vein instead of going to the hand. Symptoms include pain, coldness or tingling in the fingers or hand on your fistula arm.
If you experience any of the above symptoms you should contact your consultant or vascular access nurse.
This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.