Forming an Arterio-Venous (AV) fistula

What is a fistula?

An AV fistula is created by connecting an artery to a vein just under the skin, usually in the wrist or sometimes in the forearm or elbow. Connecting the artery to the vein causes more blood to flow in the vein, which makes the vein grow larger and stronger. This will allow the dialysis needles to be put into the bigger vein easily and allow blood to be taken to the machine for dialysis treatment then back to your body. Having a fistula means that there is less of an infection risk than having a central venous catheter. A central venous catheter is used when dialysis is needed as an emergency.

Why do I need a fistula?

You and your doctor have decided that haemodialysis treatment will be needed when your kidneys are no longer able to filter your blood as well as they should.

For a dialysis machine to work there must be a way of taking blood from you to a kidney machine; using a fistula is one way that this can be done.

Vascular Surgical Outpatient Clinic

During your clinic appointment with the surgeon, the procedure will be discussed fully and you will be shown where the fistula will be created.

An ultrasound scan of your veins and arteries of both arms may be carried out at this time. You may need a more detailed scan in the vascular laboratory at Gloucestershire Royal Hospital or Cheltenham General Hospital on a different day.

To reduce the risk of infection you will be screened for Methicillin Resistant Staphylococcus Aureus (MRSA).

What will happen during the procedure?

You will be admitted to a ward at Gloucestershire Royal Hospital or Cheltenham General Hospital.

Your procedure will be carried out by a surgeon in an operating theatre.

You will be asked to lie down in a comfortable position on a theatre couch.

The surgeon will either use local anaesthetic to numb the skin, or in some cases a general anaesthetic may be needed so that you are asleep when the AVF is created. The surgeon will then make a small cut and find the artery and vein that has been discussed with you,

and will join them together with stitches.

The cut in your skin will be sewn together, usually with stitches that dissolve but sometimes with stiches that need to be removed 7 to 10 days after the procedure.

Will the procedure hurt?

The local anaesthetic injection will sting a little to begin with, but this quickly wears off, and the area will soon feel numb. You may feel some pressure as the surgeon performs the procedure, but it will not hurt. Once any numbness wears off after the procedure, the area may feel bruised. Any discomfort from this will be helped by taking pain relief medication such as paracetamol. Please follow the dosage instructions in the pack.

How long will the procedure take?

The whole procedure usually takes up to 60 minutes, but you should expect to be with us for the whole morning or the afternoon.

What will happen after the procedure?

You will go back to the ward and the nurses will carry out regular checks of your fistula. You should be able to go home after lunch or supper, depending on the time of your procedure.

Before you leave the ward, you will be given written and spoken advice about caring for your fistula. You will also be asked to attend Ward 7b, at Gloucestershire Royal Hospital, for your fistula to be checked. This will be about 4 to 5 days after the procedure.

Are there any complications?

The procedure is usually carried out without any problems. Some minor swelling around the wound is normal. As with any procedure, there is always the risk of an infection in the wound. This can be treated with antibiotics.

You may have some minor bleeding which can usually be stopped by applying gentle pressure on the area. This does not happen very often.

Very rarely, too much blood may go into the vein, in which case the artery and vein will need to be disconnected.

If your fistula is created at the elbow there is a rare complication of steal syndrome following the procedure. Your surgeon will explain this to you at your clinic appointment and before the procedure. The risk of steal syndrome is very rare with wrist fistula.

Not all procedures to make a fistula are successful the first time. If your fistula does not work, the surgeon and your doctor will talk to you about what to do next.

Contact information

We hope that you have found this page helpful. You should feel that you have received enough information about the procedure before you sign the consent form. If you have any further questions or queries, please do not hesitate to contact the doctors, surgeon or nurses on the numbers below.

Ward 7b

Gloucestershire Royal Hospital

Tel: 0300 422 6768

24 hours

Access Nurse

Gloucestershire Royal Hospital

Tel: 0300 422 6270

Monday to Friday, 9:00 am to 3:00 pm

Your surgeon can be contacted via their secretary on the number below. Please note, you may be asked to leave a message on the answering service; the secretary will aim to return your call within 3 days.

Consultant Vascular Surgeons

Mr. David Cooper’s secretary

Tel: 0300 422 3345

Monday to Friday, 8:00 am to 4:00 pm

Mr. Sachin Kulkarni’s secretary

Consultant Vascular Surgeon

Tel: 0300 422 3355

Monday to Friday, 8:00 am to 4:00 pm

Mr. Sharath Paravastu’s secretary

Tel: 0300 422 3331

Monday to Friday, 8:00 am to 4:00 pm

Further information

Kidney Care UK

3 The Windmills, St. Mary’s Close, Turk Street, Alton GU34 1EF

Tel: 01420 541 424

E-mail: info@kidneycareuk.org

Website: www.kidneycareuk.org

Kidney Patient Guide

E-mail: kpg@pobox.com

Website: www.kidneypatientguide.org.uk