The surgical creation of an AV fistula provides a long-lasting site through which blood can be removed and returned during hemodialysis. This is the procedure that performs the functions of the kidneys in people whose kidneys have failed. The fistula, which allows the person to be connected to a dialysis machine, must be prepared by a surgeon weeks or months before dialysis is started. When the vein and artery are joined, the vein gradually becomes larger and stronger, a process that is called "maturing" and usually takes about 6 weeks.
Sometimes dialysis is only needed temporarily, but some people need it for the rest of their lives or until a kidney is available for a transplant. When kidney failure is diagnosed, time is needed to prepare the patient's body with an AV fistula that will connect the person to the dialysis machine.
An AV fistula can be created by surgically connecting any artery and a vein, however it is usually done in the forearm or the arm. When no suitable arm veins are present a graft can be used and created usually between the elbow and the axilla.
When all upper limb options have been exhausted, an AV fistula or graft can be performed in the groin or the thigh.
An AV fistula has proven to be the best kind of vascular access for people whose veins are large enough, not only because it lasts longer but it is also less likely than other types of access to form clots or become infected. If the veins are not large enough, or there is no time to wait for a fistula to develop, a graft or a catheter must be used.
Grafts are often the access of choice when a hemodialysis patient has small veins that will not likely develop properly into a fistula. This type of access uses a synthetic tube implanted under the skin of the arm that can be used repeatedly for needle placement. Unlike a fistula, which requires time to develop, a graft can be used as soon as two to three weeks after placement.
The surgical creation of an AV fistula is usually done as a day procedure and under a local anaesthetic, how ever more complex fistulas or the implantation of an AV graft is a more complex procedure that might need to be done under a general anaesthetic.
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