An arteriovenous (AV) fistula is a surgically created connection between an artery and a vein, typically in the arm, designed to provide easy access for dialysis in patients with chronic kidney failure. The fistula allows blood to flow efficiently into the dialysis machine, which filters waste and excess fluids from the blood. Dialysis is a life-saving treatment for patients with kidney failure who cannot perform these functions naturally. An AV fistula is preferred over other dialysis access methods due to its lower risk of infection and longer lifespan.

Procedures & Interventions

AV Fistula Creation

AV fistula creation is a surgical procedure that connects an artery to a vein, typically in the arm, to create an access point for hemodialysis. Over time, the vein becomes enlarged and stronger, providing a durable and reliable access for dialysis treatments. The procedure typically requires a few weeks to months for the fistula to mature, making it ready for use. This option is considered the gold standard for dialysis access due to its lower risk of complications, such as infection or clotting.

AV Graft

In cases where an AV fistula is not a viable option, an AV graft may be used. This involves connecting an artery and a vein with a synthetic tube, which provides a temporary solution for dialysis access. An AV graft is typically used in patients with smaller veins that are not suitable for an AV fistula. Though it can be used sooner than a fistula, it carries a slightly higher risk of infection and clotting.

Hemodialysis

Hemodialysis is the most common form of dialysis used when the kidneys no longer function properly. During this treatment, blood is drawn from the body, filtered through a dialysis machine to remove waste products and excess fluids, and then returned to the body. An AV fistula or graft serves as the access point for the blood to flow in and out of the dialysis machine. Hemodialysis typically requires three sessions per week, each lasting several hours.

Peritoneal Dialysis

Peritoneal dialysis is an alternative to hemodialysis where the patient’s peritoneum (the lining of the abdomen) acts as a natural filter. A catheter is surgically inserted into the abdomen, and a special fluid is introduced to remove waste products and excess fluid. Unlike hemodialysis, which requires external machinery, peritoneal dialysis can be done at home, though it is not as commonly used in patients who have an AV fistula for hemodialysis.

Dialysis Catheter Placement

A dialysis catheter is a temporary access option for dialysis patients who may not yet have an AV fistula or in emergency situations. The catheter is inserted into a large vein, often in the neck or chest, and provides a way to access the bloodstream for dialysis. While a catheter provides immediate access, it carries a higher risk of infection and clotting compared to an AV fistula and is typically used as a short-term solution.

Fistula Maintenance and Care

After the creation of an AV fistula, regular maintenance and monitoring are necessary to ensure its function. This includes avoiding tight clothing around the fistula, checking for signs of infection, and avoiding excessive pressure or trauma to the area. Healthcare providers will also assess the blood flow through the fistula regularly and perform procedures like balloon angioplasty if necessary to maintain proper access for dialysis.

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