Arteriovenous fistula





Definition

An arteriovenous fistula (AV fistula) is the connection of a vein and an artery, usually in the forearm, to allow access to the vascular system for hemodialysis, a procedure that performs the functions of the kidneys in people whose kidneys have failed. Connecting the vein and artery is a surgical procedure. The fistula develops over a period of months after the surgery.


Purpose

The surgical creation of an AV fistula provides a long-lasting site through which blood can be removed and returned during hemodialysis. 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, creating the fistula that provides vascular access years longer than other types of access and with fewer complications.

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 either an AV fistula or implantable devices that will connect the person to the dialysis machine.


Demographics

At any one time, the number of patients in the United States with kidney failure is approximately two million and rising. According to the National Kidney Foundation, by the year 2008, three million people will be expected to have what is known as end-stage renal (kidney) disease. These people can be of any age, from any background. They are typically suffering from another condition or disease that has led to kidney shutdown, and most will require dialysis. Among dialysis patients, over half will have an AV fistula as vascular access.

Description

Many advances in the treatment of kidney failure have been seen since the first attempts at dialysis treatments were made in the 1920s. At one time dialysis was only thought of as a way to keep people alive until kidney function could be restored. Often the treatment for kidney failure had to be discontinued within several days because patients' veins could not endure the trauma of frequent withdrawing and replacing blood. The first breakthrough came in 1960 with the introduction of an implantable Teflon tube, called a shunt, that was the first effective vascular access device. Since then, the development of the AV fistula has marked another important advance, allowing effective treatment for longer periods of time. The goal of researchers and medical institutions is to continue to improve treatment and improve the length and quality of life for people with chronic kidney failure.

The kidneys are two organs in the mid-abdomen, one on each side of the middle back. Their function is to clean the blood of wastes and regulate fluid and chemical balance in the body. Dialysis performs these functions in place of the failing kidneys. Dialysis cannot restore the kidneys, but it can prolong life, often for years, by preventing the build-up of waste products in the body. Acute kidney failure can happen in many conditions and diseases that place an extra burden on the renal system, such as in advanced kidney and liver diseases; in rapidly progressing terminal illnesses, such as cancer and certain severe anemias; after severe allergic reactions or reactions to drugs or medications; in diseases that involve the vascular system, such as heart and lung diseases or the formation of blood clots (embolism); and often following heart bypass surgery. Diabetes and vascular diseases, especially those with hypertension (high blood pressure), are the two most common underlying diseases contributing to chronic kidney failure.


Hemodialysis

Dialysis is performed as critical life support when someone suffers acute or chronic kidney failure. It is a mechanical way to cleanse the blood and balance body fluids and chemicals when the kidneys are not able to perform these essential functions. Because kidney function can be reversible in some cases, dialysis can provide temporary support until renal function is restored. Dialysis may also be used in irreversible or chronic kidney shutdown when transplantation is the medical goal and the patient is waiting for donated kidneys. Some critically ill patients, with life-threatening illnesses, such as cancer or severe heart disease, are not candidates for transplantation and dialysis may be the only option for treating what is called end-stage renal disease (ESRD).

There are two types of dialysis, hemodialysis and peritoneal dialysis. In hemodialysis, the blood circulates through a machine outside the body and is filtered as it circulates. In peritoneal dialysis, the blood is filtered through a membrane that has been placed in the abdomen. Blood remains in the body and waste material is filtered into an exchange fluid through an opening in the abdomen called a port. Only hemodialysis requires an AV fistula or other vascular access.

Hemodialysis circulates blood through a dialysis machine that contains a filter membrane. The blood is slowly pumped out of the body and into the machine for filtering. After being filtered, the blood is returned to the body through the same vascular access. About one cup of blood is outside the body at any given moment during the continuous circulation process.

Hemodialysis is usually done three times a week, taking between three and five hours each time. Healthcare professionals perform the procedure either at independent dialysis centers or in hospitals or medical centers. Dialysis patients must go to the hemodialysis center where they will sit to receive the treatment. Although they cannot walk around, they can watch television, read, or talk to other patients. The dialysis center offers patient education, including videos and brochures that describe treatment options and self-care. Patients can also be given advice and information about paying for this ongoing treatment through nationally sponsored programs that are available especially for dialysis patients. Often the dialysis center offers emotional support as well, letting people meet and talk with other people who have kidney problems. Some people prefer to perform their own dialysis by having a home dialysis machine. This requires that the dialysis patient and another person, usually a family member, take a three- to six-week training program to learn how to do the treatment.


Vascular access

An access or entry to the vascular system is needed to perform the blood-cleansing role of the kidneys through hemodialysis. There are three types of vascular access: arteriovenous fistula, grafts, and catheters.

ARTERIOVENOUS FISTULA. 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.

GRAFT. 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. Grafts are known to have more problems than fistulas, such as clots and infection, and will likely need replacement sooner.

CATHETER. A catheter may be used to provide temporary vascular access. When kidney disease has progressed quickly, there may not be time to prepare permanent vascular access before dialysis treatments are started. The catheter is a tube that is inserted into a vein in the neck, chest, or in the leg near the groin. Two chambers in the tube allow blood to flow in and out. Once the catheter is in place, needle insertion is not necessary. Catheters are effective for dialysis for several weeks or months while surgery is performed and an AV fistula develops. They are not selected for permanent access because they can clog, become infected, or can cause the veins to narrow. Long-term catheter access must be used in patients for whom fistula or graft surgery has not been successful. If more than three weeks' use is expected, catheters can be made to tunnel under the skin, which increases comfort and reduces complications



Diagnosis/Preparation

Diagnosis

The diagnosis of kidney disease and its progression to kidney failure is typically made by a nephrologist, a specialist in kidney structure and function. The nephrologist will determine whether the patient has acute or chronic kidney failure and if dialysis is appropriate for the patient. If dialysis is recommended, the nephrologist will determine if an AV fistula is the ideal vascular access for the patient. To make these determinations, the nephrologist will need to be aware of the patient's general condition, especially the presence of any underlying disease. Kidney function must be evaluated and determined to be seriously impaired before dialysis is recommended. It is typically started when kidney function is down to about 10% of its normal level. Among other tests that will be performed, such as urinalysis with microscopic examination of the urine, several blood and urine tests can be used to measure a person's kidney function when chronic or acute kidney failure is suspected. Some of the tests measure chemicals produced by the body that are normally excreted (passed in urine) by the kidneys; the tests can measure how much is passing through, and how much remains in the blood, and then determine how well the kidneys are functioning compared to normal. These tests include, but are not limited to:

  • Serum creatinine, found in higher levels in the blood if kidneys fail.
  • Urinary creatinine, lower in kidney failure.
  • Urinary output, measuring both fluid intake and all urine produced.
  • Urinary osmolality, measuring the concentration of the urine, an indicator of kidney filtering ability.
  • Blood urea nitrogen (BUN), harmful nitrogen waste that increases in the blood as kidney function decreases.
  • Electrolytes in blood and urine, minerals that result from the breakdown of salts (sodium, potassium, magnesium, and chloride), often out of balance when kidneys fail. Potassium, for example, increases in the blood during kidney failure and can cause heart irregularities.

Description

Surgery to create an arteriovenous fistula is usually conducted using a local anesthetic, injected at the site of the proposed fistula. The procedure is performed in a hospital or one-day surgery center and can usually be performed on an outpatient basis if the patient is not already hospitalized. After cleaning and sterilizing the site, the surgeon will make a small incision in the forearm sufficient to allow the permanent joining together of a vein and an artery in the arm. The blood vessels will be appropriately blocked to stop blood flow for the procedure and incisions will be made to join them. Silk sutures, just as those used in other types of surgical incisions, will be used to close incised areas as needed after the vein and artery have been joined. Once joined, blood flow will increase, the vein will become thicker, and over a period of months the connection will become strong and develop into the fistula that will allow permanent vascular access.


Aftercare

The hemodialysis patient should expect needle insertion in the AV fistula at every dialysis session. Patients who prefer to insert their own needles or who perform dialysis at home will need training, and all patients will have to learn how to avoid infection and to protect vascular access. Because vascular access problems can lead to treatment failure, the AV fistula requires regular care to make dialysis easier and to help avoid clots, infection, and other complications. Patients can help protect the access by:

  • Making sure the access is checked before each treatment.
  • Not allowing blood pressure to be taken on the access arm.
  • Checking the pulse in the access every day.
  • Keeping the access clean at all times.
  • Using the access site only for dialysis.
  • Being careful not to bump or cut the access.
  • Not wearing tight jewelry or clothing near or over the access site.
  • Not lifting heavy objects or putting pressure on the access arm.
  • Sleeping with the access arm free, not under the head or body.

Risks

The most frequent complications in hemodialysis relate to the vascular access site where needles are inserted. This can include infection around the access area or the formation of clots in the fistula. Usually, because they are in the fistula itself and do not travel to other parts of the body, these clots are not life-threatening. The greatest danger is that clots may block the fistula and would have to be removed surgically. Frequent clotting may require creating a back-up fistula at another site, to allow dialysis when one access is blocked.

There are other complications from dialysis that are not directly related to the vascular access. For example, when the kidneys have shut down, they produce very little urine. Because dialysis is the only way people with kidney failure can balance fluid levels in their bodies, hemodialysis can cause bloating and fluid overload, indicating that too much fluid remains in the body. If fluid overload occurs, the patient will have swollen ankles, puffy eyes, weight gain, and shortness of breath. Fluid overload can cause heart and circulatory problems and fluctuations in blood pressure. Medications may be prescribed and changes in fluid intake or diet may be made to help balance fluids safely in conjunction with dialysis.

Other problems that can occur during or after hemodialysis include:

  • Low blood pressure, if fluid and wastes are removed from the blood too quickly.
  • Nausea, because of changes in blood pressure.
  • Muscle cramps from the removal of too much fluid from the blood.
  • Headaches near the end of a dialysis session, due to changes in the concentration of fluid and waste in the blood.
  • Fatigue after treatment, lasting sometimes into the next day.

Normal results

An AV fistula can usually be created and can function well with no adverse affects in a person whose veins are large enough. The amount of time, usually a matter of months, it takes to develop the fistula after surgery will depend upon the size and strength of the patient's blood vessels and on the person's general condition and nutritional status. When the fistula develops, the thickened vein that has been joined to an artery can be seen in the arm and a pulse can be felt. The early development of an AV fistula as access for long-term dialysis has been shown to improve the survival of patients with chronic renal failure, and reduce the chances of being hospitalized with complications. It also gives them a better opportunity to choose self-dialysis as their treatment.

With good nutrition and a fully functioning AV fistula, dialysis patients can be relatively comfortable and free of complications. People may become tired and uncomfortable when it is nearly time for their next dialysis session. This is to be expected because wastes are building up in the blood, and the body senses that it is time to remove them.

Morbidity and mortality rates

The earlier use of dialysis, especially with AV fistula access, has been shown to increase survival in patients with renal failure. The AV fistula is designed to improve the effectiveness of dialysis and is reported to present fewer risks and complications than other vascular access, such as reduced incidence of clotting and infection, and longer use overall.

Kidney failure is reported to account for 1% of hospital admissions in the United States. It occurs in 2–5% of patients hospitalized for other conditions, surgeries, or diseases. In patients undergoing cardiac bypass surgery, 15% are reported to require dialysis for kidney failure. Overall deaths in people undergoing dialysis are reported to be 50% because of the multi-organ dysfunction that has influenced kidney failure.


Resources

ORGANIZATIONS

National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800)622-9010. http://www.kidney.org .

National Kidney and Urologic Diseases Information Clearinghouse. 31 Center Drive, MSC 2560 Building 31, Room 9A-04, Bethesda, MD 20892-2560. (800)891-5390. http://www.niddk.nih.gov .


OTHER

Getting the Most From Your Treatment: What You Need To Know About Hemodialysis Access. Booklet. New York: National Kidney Foundation, Inc. (800)622-9010. http://www.kidney.org .

NIDDK Kidney Failure Series. Booklet. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. Email: nkudic@info.niddk.nih.gov.

Vascular Access to Hemodialysis. National Kidney and Urologic Diseases Information Clearinghouse, Home Health Information. December 1999. http://www.niddk.nih.gov .


L. Lee Culvert

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


The surgery to create an arteriovenous fistula for vascular access in hemodialysis is performed by a general surgeon or vascular surgeon in a hospital or one-day surgery center. It requires only local anesthesia and can be performed as an outpatient procedure.

QUESTIONS TO ASK THE DOCTOR


  • Why are you recommending an AV fistula instead of another kind of access?
  • How will an AV fistula make dialysis easier or better for me?
  • How often do you perform this procedure?
  • What will the fistula look like? Feel like?
  • Should I treat my fistula arm in any special way?
  • Are there activities I should avoid?
  • How long will the AV fistula last?


User Contributions:

Aseem Mishra
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Aug 2, 2006 @ 6:06 am
I m a Doctor and I came through this article while searching for matter regarding AV Fistula formation, its wonderful and and helps me explain to my patients in a much better way regarding Av Fistula formation.
Dr. Tom M. Omulo
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Sep 16, 2008 @ 8:08 am
I am a kenyan doctor practising vascular surgery, i have constructed many AV fistula, would like to coolaborate with the authors especially to promote and advocate more fistula use
SIJI
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Sep 24, 2008 @ 12:12 pm
I AM NURSE I READ THIS ARTICLE REALY INFORMATIVE .
whitney
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Nov 5, 2008 @ 4:16 pm
i am currently a student nurse and i found this article to be very helpful for me to understand a fistula.
EEvita
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Dec 14, 2008 @ 3:15 pm
Im currently a student nurse i was able to do a homework about av fistula with the help of this article.thank you
D. Satheesh Kumar
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Jan 1, 2009 @ 4:04 am
This is really very usefull article for medical transcriptionists. Thank you so much for your work.
David C. Untalan Jr.
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Mar 7, 2009 @ 2:02 am
i am a mutual friend of a nurse and this is her topic (AV Fistula), and i found this article very informative and exactly for her report, for sure! she will be impress of my deeds. i thank you very much to the author of this article.
Manish Kanchhal
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Jul 1, 2009 @ 12:12 pm
The article is really wonderful clarifying most of the doubts a person whether patient or attendent can get. However, it does not say as to how to improve the fistula / size of artery & veins once the fistula is made. If someone can through some light on this issue pls revert on the above email id. Its urgent required for my mother who has the fistula made before a month and its still underdeveloped for dialysis. Thanks
R.ASWIN KUMAR
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Jul 12, 2009 @ 12:12 pm
i am a nurse workling in apollo hospital. It is useful for OT nurses who are scrubing A.V.fistula case.
Michelle
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Jul 30, 2009 @ 11:23 pm
I am a student in the dialysis technician program and this information was very useful. My only question is where is the information about the pros and cons of an AV fistula, AV graft and a catheter. I think people might want to know both the good and the bad of all accesses. Otherwise, thanks for the insite.
Michelle
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Jul 30, 2009 @ 11:23 pm
I am a student in the dialysis technician program and this information was very useful. My only question is where is the information about the pros and cons of an AV fistula, AV graft and a catheter. I think people might want to know both the good and the bad of all accesses. Otherwise, thanks for the insight.
dr nazrul
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Aug 9, 2009 @ 12:12 pm
I am a bangladeshi radiologist.this article is very much informative.it would be more fruiteful if there is information about complications/sequelae of AV fistula &some refference of long term used fistula included here.
Kathleen
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Sep 9, 2009 @ 9:21 pm
I found some incorrect information in the beginning of this article. I am a kidney failure patient who has read quite a lot about av fistulas. I received one myself five weeks ago. Where this article is titled "Hemodialysis", it states that there are 2 types of it. True, but in describing peritoneal dialysis, it states that a membrane is placed into the abdomen. False. I'm sure it is supposed to say a catheter is placed. I am very sure you will want to reread that section.
Nicole
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Sep 30, 2009 @ 5:17 pm
This article is highly informative and helps me a lot in understanding this whole process. My father is going tomorrow to have the surgery done on his arm for the fistula formation and this article basically told me everything that I need to know. Compliments to the author(s)
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Feb 17, 2010 @ 8:20 pm
I had a kidney transplant about 2yrs ago and i desire to have my AV fistula removed. What are the complications/dangers that could arise?
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Apr 10, 2010 @ 1:01 am
I am nephrology physion since 1994 -also i interest in this field where we face daily problems in this programm and i need more information and practical veiw on it.
thank u
Dr.saher
head of 2-march hemodialysis center
tripoli libya
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May 2, 2010 @ 8:20 pm
Being in Stage 4 CKD and facing the prospect of needing dialysis in the not so distant future, I found this article to be informative and helpful. I do not doubt that my nephologist knows all about AV fistulas and other options for dialysis, but I am sending him a brief extract from this article. I plan to ask him about creating an AV fistula now so that it will have time to reach the necesssary condition before I begin hemodialysis.

Thank you.
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Jun 18, 2010 @ 12:00 am
Post traumatic a v fistula in arm. I had open heart surgery in 2005. I began having pain in my right arm.I was toled that time will take care and a collateral circulation will be created. I do not desire more surgery but the pain at the site where all the needles were placed has increased.Is there any way other than surgery? I>L>
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Jun 18, 2010 @ 7:19 pm
Can a fistula in your upper arm be removed if you decide you aren't doing dialysis? My dad has one for 5 years and has decided not to do dialysis if needed and wants the fistula out so they can use that arm for blood work and IV's is neccessary...can it be removed and then the arm be used for blood work , bllod pressure and IV"S?
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Jun 19, 2010 @ 4:04 am
wishes to know new articles on A-V fistula under supraclavicular blocks
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Jul 8, 2010 @ 6:06 am
I am a resident doctor intersted in vascular surgery
the article is really informative
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Jul 15, 2010 @ 9:09 am
I have had an AV Fistula now for 26yrs and have had no problems with it apart from it becoming larger over the yrs ... i have been advised to have it removed as i have not on dialysis now for 26yrs ( was on dialysis for a short period only 4mths) its a gr8 party trick :)
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Oct 14, 2010 @ 2:14 pm
This is a well organized article that generally covers the basics of Dialysis Grafts. As a sonographer with experience in performing various diagnostic procedures, I found this to be useful for not only me, but the general public as well. Well done...
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Feb 27, 2011 @ 3:15 pm
I've been a Dialysis patient for twenty years. Self patient on and off for about five. The experience and knowledge that I have compared with this site I consider very good material. Even though it's commercial, good job on the information provided.
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Apr 5, 2011 @ 3:03 am
What will the fistula look like? Feel like?

what if the patient develop hypotension during treatment?
bessy
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Apr 22, 2011 @ 2:14 pm
the article seems to be interesting and knowledgeable
Jose
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Apr 25, 2011 @ 7:07 am
I am a Diabetic, heart failure and I also required Lipopheresis/infusion Therapy. This information is very helpful. I have a fistula on my left wrist. I have to have surgery to removed blockage on the fistula. I required Lipopheresis because I am a critical patient of my doctor. Doctor advices that I might have 1 year of life if I do not get this procedure. I am now on Medicaid and there is a battle between doctor and insurance. The clinic will not do the procedure until they get paid. The insurance said they will pay but the doctor is not sure. So I am caught in the middle, not getting this life saving procedure. I could start having organ damage. My diabetes has gotten worse and I am getting sick because I have not done procedure in almost 6 months. My heart is struggling as well. I quest when it comes down to it a patient health and life comes last before the dollar. I glad you put this information down, it helps to know more about the fistula and its care. Thanks!
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Jun 25, 2011 @ 5:17 pm
can a fistula be reversed if it is causing lack of blood flow to the hand and fingers?
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Aug 31, 2011 @ 12:00 am
I have a special needs child (43) who had a AV Fistula placed in her leg in 2009 and she is a diabetic. To begin with 2007 she had fistulas in her right and left arm ,graft and A/V, which did not work out . The graft (use of man made material) clotted before she was out of surgery.
Well the reason I am commenting is to say that the fistula in the leg has been wonderful. We
start our 3rd year soon. Only problem(s) have been after treatment clotting off. Taking 20 minutes to an hour to clott. WE have had many fistula-grams. The radiologist has done a couple of angioplasties. I just hope the technicians at dialyis don't ruin it. I have noted in the last 4years that dialysis centers (techs) and our vascular surgeon have had a few go arounds
with what he calls beating up the fistula. They don't seem to understand that fistula is our
LIFE line. I wish I could find more information on fistulas in the leg. I know that it takes more time to clott after treatment. I know for our family we waited 2 years until we got something that worked for us. For us the fistula in the leg was/is a blessing.
susmitha
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Sep 15, 2011 @ 3:03 am
My brother in law had kidneys failure and he was very much in doing the fistula surgery. This article helped perfectly to know about the surgery. Thanks for the information.
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Sep 15, 2011 @ 6:06 am
its really informative for the people like me working in helth care profession...expecting more articles
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Sep 22, 2011 @ 12:12 pm
iam a kidney failure patient who had negative experiences with both catheter and av fistula procedures. Found above information very useful and informative. Thanx.
Would appreciate diagram sketch of both procedures as they relate to the body. (veins and arteries).
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Oct 10, 2011 @ 8:08 am
Im a nurse and may dad just had an av fistula graft transposition, so im always worried about things that concern it, thanks to this article it just cleared my mind.
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Oct 29, 2011 @ 1:01 am
my younger brother whose only 22 suffered from chronic kidney disease stage 5, i am a nurse on a general ward. he is undergoing dialysis treatment to the hospital which i work. the management knew about my brothers condition, and they transferred me to the the dialysis department to understand and learn more about the dialysis treatment, how it is done and how to operate it. till im the one performing it to him and the rest of the patients. i pray not only for my brother but for every dialysis patient, may GOD cure you from this kind of sickness..
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Nov 13, 2011 @ 10:10 am
Hello.. My mother has been suffering from Poly Cystic Kidney Diseas, Our Nephrologist Advised Us To Creat an A. V. Fistula we Are Very Anxious about What is It? After Searching I Come Across Ur Excelent Article On This Subject it help us a lot.. Thank you.
Jean
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Feb 6, 2012 @ 9:21 pm
My spouse has been a diabetic for 10 yrs. He now also suffers withhigh blood pressure and has a low blood count of 4. He has to have dialysis done and an AV Fistula must be created on his arm. I read the article and now understands everything I need to know because the nephrologist did not explain anything to us. The article was really informative.
vonna
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Mar 2, 2012 @ 6:06 am
i have a question about of arteriovenous shunt inserted for hemodiaylsis. why is not notify the physician if a bruit is heard in the cannula?
Gucci
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Mar 23, 2012 @ 11:11 am
oh honey. I am so so so sorry.How was the appt? Any promising news?On a way side note- there are cmnpaoies that can help your Mom with your Grandma's house. Think they are called estate realtors or something like that. A lot of churches will have information on some reputable people to help. I'm sure your Mom will want to be hands on- but having to deal with that ( all of the emotions involved) and having to grapple with these new test results wow. Some hard core stuff.I will be thinking of all of you.xoxoCali
theja
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May 21, 2012 @ 1:13 pm
It gave me some idea. I was interested as I am presently a male dialysis nurse.
Keiko Omori
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May 28, 2012 @ 5:17 pm
I asked: The percentage of AV fistula surgery that are unsuccessful. Mine was a failure. The surgeon who performed the surgery said it was because of a blood clot. He said 25% experience blood clots. While in recovery a nurse and residen listened for a "pulse" in the area of the surgery. The resident who was in surgery took about awhile and finally said "It's faint, but it's there." What is the successful rate for fistula surgery?

Thank you for your consideration.
donna
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Jun 7, 2012 @ 7:07 am
my dad is at-the-moment undergoing a AV FISTULA procedure in the Philippines and im here in UAE. This article is very informative. Though Im far, im having a clear image of what he's undergoing now and what will be his condition in the next coming weeks and months.. thanks a lot!
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Jun 23, 2012 @ 12:00 am
This was very informative since I just received a letter from the hospital.It said I have an appointment with the vascular surgeon in less than a month.Now that I know what to expect. I feel so much better.Thank you.
Efrain
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Jul 6, 2012 @ 7:19 pm
is their anythinbg that can be done when they say clotting has stopped them
Mike
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Aug 3, 2012 @ 3:03 am
What is the timeframe before an AVF can be used? I know that some patients would tend to used their newly created AVG almost immediately or within the week - is this okay.

They used it so soon as most of them says it's too troublesome having 2 entry points vide perm cath & AVF.

Anyway, the write-up was superb & informative, Thanks
A-Razaque Ahmes
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Aug 14, 2012 @ 1:13 pm
If the renal failure cures is it safe to reverse the AVF and what are the chances of of a complete back to normalcy?
Kirk Blackwell
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Aug 20, 2012 @ 7:19 pm
Should an AVF be put on the same side of the patient that has a pacemaker defibrillator and a synchronizer. My father had this done an he has had very bad swelling in arm since surgery . We have been told in so many words that it probably should have been put in other arm. What should our next step be to correct this problem?

t
Thanks!
Richard Patterson
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Aug 31, 2012 @ 12:00 am
is it possible to perform an operation to the patient soon after dialysis
Richard Patterson
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Aug 31, 2012 @ 2:02 am
is it possible to perform an operation to the patient soon after dialysis
Debi Willoughby
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Sep 11, 2012 @ 9:21 pm
I have had a AV fistula for 6 years I did diaylsis for 6 months then I got a transplant and have done well with it until the last 6 weeks I am stage 4 kidney failure again. but I started having severe pain in my av fistula arm and severe swelling in arm and fingers and all right side of my body. I went to my sergon and he told me to get cardic clearnence which I did not pass my ehco showed a lot a fuild around my heart I had a cardaic window done but my swelling is still very bad the doctors wont do anything because they think it will put be in kidney failure again, Do you think it is wise to continue with this without doing anything?
Michael Knight
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Dec 18, 2012 @ 9:09 am
I would like to know if IV insertion can be made in the arm that has an AV fistula. I have been told that you can't access below a fistula and/or graft, but you may insert an IV above the fistula/graft. I am on the IV team at the Univ. of Michigan and we have some patients that have a fistula/graft in each arm but IV access is requires. Any suggestions please?
Carol
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Feb 26, 2013 @ 11:11 am
I am about to have an AV fistula implant and have been informed by the hospital that general anesthesia is required, yet this article states multiple times only a local is required. ???
Dr. M.A.Jaffer
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Mar 30, 2013 @ 3:03 am
I would like to know what is the average logitivity of the AVF when primary , and what is it if a graft is used. thanks
Phindile P
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Apr 7, 2013 @ 6:18 pm
I'm stage five kidney problem and I have an ectopic kidney the one on my right hand side its not on its renal bed but the left kidney is norman,I'm 36yrs and the doctor told me dat on the 11.04.2013 I'll be going for AV Fistula on my left hand side so what I'm asking is dat how long its gonna take to have that in my arm? The second question is dat my Creatinine its gone up to 389 so once I've started dialysis the creatinene will drop n my kidney will work normal or I have to be dialyed for the rest of my life? And I'll be going under hemodialysis (bags) not machine one. Third question is once I've started dialysis its not gonna affect my right kidney and get sick?

Thank you so much
Tim
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May 20, 2013 @ 3:15 pm
I had my fistula removed 10 years ago after it was damaged while I was breaking up a fight at work. Ever since, there had been a raised spot on my wrist where the fistula had been that had continued to buzz with bloodflow from where my fistula had been. I fear I damaged it this weekend while moving some furniture. The spot no longer buzzes and it has turned hard and painful to the touch, and my hand has had a dull pain in it for a couple days. My question is, does it matter? Do I need to go to the doctor, can it hurt me to just let it be.
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Aug 8, 2013 @ 4:04 am
Hi, my dad is an hemodialysis patient and he also has a pacemaker. Can I know the risks of having
a pacemaker transplanted near the fistula? Thanx.
sheri
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Oct 1, 2013 @ 12:00 am
Loved this article. I'm a 41yr old female with alports an in stage 4. This past march my nephro says I may need to start dialysis in about a yr. So it's been 6 months. I have an appt in October with nephro, is it too soon to ask him to send me for my fistula eval ? Thanks for your help
sumesh
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Nov 20, 2013 @ 11:11 am
Today my father aged 62 admitted in royal sut. Trivandrum kerala.for avf surgery my question is he suffering with a chronic kidneys problem if soo what will be the cost of heamodialysis
rhodalyn soto
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Jan 4, 2014 @ 4:16 pm
My friend ask me if there will be a problem if she injected IM at patients arm where the av fistula also located?
Cass
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Jan 4, 2014 @ 6:18 pm
I'm new a this, my mom has been taking dialysis due to a hospital stay where a large amount of antibiotics were used to save her life. She's been given a order to have the Arteriovenous Graft performed. I'm nerves and would like to know if there are any other options. She now the Venous Catheter; which would be nice it could stay in place. She's diagnosed as Acute. Please advice.

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