What is an AV Fistula?
An arteriovenous (AV) fistula is a surgical connection between an artery and a vein, usually in the forearm. This creates a stronger blood vessel that can handle the high blood flow needed for hemodialysis. An AV fistula is considered the gold standard for dialysis access because it has the lowest risk of infection and clotting compared to other access types.
Dr. Rajesh Goel recommends creating an AV fistula well before dialysis is needed (ideally when GFR drops below 20-25), as it takes 2-6 months to mature before it can be used.
The Procedure
Pre-Op Assessment
Ultrasound of arm vessels to assess suitability. Blood tests for surgery clearance.
Surgery
Performed under local anesthesia (1-2 hours). Small incision in the forearm.
Connection
Artery and vein are connected surgically. Blood flow increases through the vein.
Maturation
The fistula needs 2-6 months to mature and strengthen before dialysis use.
AV Fistula vs Other Access
| Feature | AV Fistula | AV Graft | Catheter |
|---|---|---|---|
| Infection Risk | Lowest | Moderate | Highest |
| Clotting Risk | Lowest | Moderate | Highest |
| Maturation Time | 2-6 months | 2-4 weeks | Immediate |
| Longevity | Years | 1-3 years | Weeks-Months |
Fistula Care Tips
- • Check for the "thrill" (buzzing sensation) daily
- • Keep the arm clean and dry
- • Do not let anyone take blood pressure on that arm
- • Avoid tight clothing or jewelry on that arm
- • Do not sleep on the fistula arm
- • Report any swelling, redness, or loss of thrill immediately
Schedule Surgery
Create your AV fistula well before you need dialysis. Consult Dr. Goel for evaluation.