What is it?

An arteriovenous fistula or AV fistula is a connection between an artery and a vein beneath the skin, that can be created through a minor surgical intervention. After it has been placed, an AV fistula cannot be used straight away. It has to mature (i.e. develop) first, meaning that the vein must enlarge and the vascular wall must become stronger. Usually, the AV fistula can be used after four to six weeks.

If your own veins are not suitable for the creation of an AV fistula, the surgeon may decide to use an artificial blood vessel. This is a specially designed blood vessel that is connected to an artery and a vein, connecting both blood vessels. The artificial blood vessel is placed in the lower arm via a surgical procedure. Often, the artificial blood vessel is placed as a loop, but it may be straight too.

Course of the procedure

Preparation for the procedure

During the consultation with the vascular surgeon, it is determined in which arm the AV fistula can be placed. The selection is made based on the condition of the blood vessels in your arm and on whether you are right or left-handed. If your own blood vessels are not suitable for the creation of an AV fistula, an artificial blood vessel may be opted for. An AV fistula is placed in the wrist or, if that is not possible, in the lower arm or elbow. This connection is made surgically, under a light general anaesthetic or, if possible, under a local anaesthetic.
During this consultation the date of the procedure is decided upon. You will usually be admitted for one night. If you take blood-thinning medication, your physician will inform you how to adjust the dose of this medication.

The procedure itself

The procedure is performed under a light general anaesthetic or, if possible, under a local anaesthetic. After the operation, you will remain in the recovery room for a short while.

After the procedure

After the procedure, you will have a wound on your arm. The wound edges will be closed using sutures so that they can grow together again. Sometimes, a wound drain is placed. This is a kind of tube through which blood and wound exudate can be drained. The first days after the operation, the hand and lower arm may be swollen. When you are in bed, you can raise your lower arm slightly by placing it on a pillow. The sutures are removed after approximately ten days. You must keep the wound dry in this period.

During each consultation with the nephrologist or while you are at the Dialysis Department, your fistula arm will be monitored on the outside and checked for sufficient blood flow through the AV fistula. When the AV fistula has sufficiently matured (after approximately six weeks) and there is no sign of infection, injury or skin rash, the AV fistula can be needled for the first time.

Centres and specialist areas

Nephrology

Latest publication date: 05/02/2021
Supervising author: Dr De Vleeschouwer Mieke