An arteriovenous (AV) fistula is a type of access used for hemodialysis. It is relevant whether you do your own house haemodialysis (HHD) or dialysis at a facility. It is a procedure wherein an artery is attached to a superficial vein, causing the vein to enlarge over time and enable faster blood pumping during the dialysis process. The fistula, which lies beneath the skin, is utilized to enter the bloodstream during dialysis. Dr. Tapish Sahu is a renowned Vascular Surgeon in Delhi who specializes in performing AV Fistula surgeries. He is considered one of the best doctors for AV fistula surgeon in Manipal Hospital Delhi. Because fistulas use the patient’s vessels and don’t require the permanent implantation of foreign materials like those needed to generate an AV graft or catheter, they are the preferred method of access.
How are AV fistulas operated?
Deeply nested beneath the skin, arteries have high blood pressure and transport cleansed blood throughout the body. Veins are visible beneath the skin and carry impure blood throughout the body. When an artery is connected to a vein, the vein’s pressure rises and eventually causes it to swell and thicken, allowing needles to be inserted to extract blood for dialysis.
How is the operation carried out?
Surgery for an AV fistula is typically performed on the hands, either in the arm or forearm. The non-dominant hand, which is typically the left hand, is favoured. Usually, local anaesthesia is used while doing it. It can be completed on a day-care basis and ended on the same day.
After surgery, engaging in fistula exercise
Your doctor will advise you to work on strengthening the AV fistula after it is surgically made, as it needs to mature for several weeks or months before it can be used for haemodialysis. The sooner you can use your fistula, the more access arm exercises you perform to help strengthen it. Your physician could suggest specific finger and arm exercises to help strengthen the fistula. The location of your fistula will determine the workouts your doctor suggests. Usually, fistulas are seen in the upper arm or forearm. See your physician before beginning any fitness regimen.
After surgery for an AV fistula, dos and don’ts:
Dos:
• Until the wound heals, which may take ten to fourteen days, keep it clean.
• Sutures will be removed in 10-14 days, and sometimes absorbable sutures are preferred by some surgeons.
• For the first two to three days after surgery, keep the arm raised with a cushion to support it until the operated hand’s swelling goes down. Hand swelling is frequently caused by elevated venous pressure and usually goes down in three to seven days. It is best to see a vascular surgeon if it lasts more than ten days.
• Following the pain and swelling have subsided, begin exercising the fistula hand by squeezing the sponge ball two to three days following the procedure. It has to be completed during free time or at least three times daily for 10 minutes.
· Press your fingertips against the skin covering the fistula at least twice a day to experience the thrill (vibration). If it stops, get medical attention right away.
Don’ts: • Avoid taking blood pressure on the arm that has a fistula.• Avoid drawing blood from the arm with the fistula.
• Steer clear of jewellery or tight clothing around the fistula arm.
• Refrain from administering any injections or infusions to the fistula arm.
• Don’t sleep on your arm that has a fistula.
· Refrain from using your fistula hand to lift large objects or shopping bags.
• Refrain from exerting a lot of pressure on the fistula hand.
How long will it take for the fistula AV to enlarge?
The fistula will take about “six” weeks to fully develop. We can use it early in some patients. For some, it might take a long time to mature. A good fistula should have a diameter of 6mm and a length of 6 cm.
What AV fistula complications exist?
While infections are extremely rare, they can occur both during and after surgery.
Thrombosis: The AV fistula may form clots. This frequently occurs if the blood pressure falls during or following haemodialysis. Blood thinners (Asprin or Clopidogrel) are advised if it occurs frequently.
Arterial steal phenomenon: In some cases, the fistula hand’s fingers may become chilly, numb, or painful. This is due to a compromised blood supply to the distal part of the hand and “steal” of blood from the artery to the vein.
Aneurysms: During an AV fistula, swelling in the hands is observed when It’s been in use for a while. It results from the blood vessel walls becoming thinner. In these situations, the needle prick location needs to be adjusted. Consult a nephrologist if the bulge is substantial as there is an uncommon possibility of bleeding from these locations.
Is it uncomfortable to needle the AV fistula?
In the early going, it could be uncomfortable. Some ointments and lotions can be used 30 to 60 minutes before dialysis and have been shown to significantly lessen pain. Patients will eventually become less sensitive to pain and adjust to the therapy.
If the AV fistula site is bleeding, what should I do?
There’s a possibility that you could bleed from the patient would have received heparin at the fistula site following dialysis. Tourniquets are knotted on the cannulation site following dialysis for the same reason, and they must be removed after 4–6 hours. In the unlikely event that bleeding occurs at the fistula site after removal, do not panic. Apply point compression there for ten to fifteen minutes right away. If the bleeding is significant, get in to your dialysis centre.
Summary
Because AV fistulas are healthier, simpler to maintain, and yield better outcomes than alternative access techniques, more than half of dialysis patients currently use them. Dialysis treatments might be more effective and manageable if your fistula is taken care of with strengthening exercises, regular cleanings, and daily checks for healthy blood flow. If you are advised to go for AV fistula surgery, it’s important to look for a Vascular surgeon who is specialized for these surgeries. Dr. Tapish Sahu is an expert in this field and works in the capacity of Director of Vascular Surgery at the Manipal Group of Hospitals in New Delhi. He was previously a senior consultant with Medanta. For more information pls visit https://www.vascularcareindia.com/
