Arteriovenous Fistula 101
There are three main types of vascular access. They are the arteriovenous fistula, the arteriovenous graft, and the venous catheter. The most preferred method of vascular access is the arteriovenous (or AV) fistula. This is where a vascular surgeon creates a direct connection between an artery and a vein. It should be understood that although the vast majority of vascular accesses are created in the patients arm, but they can be created in the leg, as well.
An AV fistula has several advantages over the other methods. They include lower rates of complications, clotting, and infection. AV fistulas also require less maintenance than an arteriovenous graft. Since it may take months for one of these fistulas to become strong enough and durable enough to handle a dialysis treatment, they need to be planned for ahead of time.
Although AV fistulas provide good blood flow for dialysis, and last longer than other types of access, infections still pose the greatest threat so patients need to be aware of any pain, tenderness, swelling, or redness around the access area. If you notice any of these warning signs or a fever, you should contact their doctor immediately.
Creating an AV fistula is most commonly an out-patient procedure which requires only a local anesthetic. Ultra sound or other techniques may be used as part of a blood vessel mapping procedure prior to surgery. This allows the doctor to check position and blood flow in order to select the blood vessels that will be the best candidates for the procedure. If, after 2 or 3 months the fistula doesn't appear to be maturing, the surgeon will need to repeat the procedure.
Once the fistula has been created, the doctor will explain in detail how to keep the area clean and will go over things to promote good blood flow through the area, such as never allowing a blood pressure cuff to be placed on the access arm. The doctor or vascular surgeon will be able to address any questions or concerns the patient may have, either before or after the procedure, so take advantage of this resource.
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