Dialysis Fistula

What is a dialysis fistula?

A dialysis fistula (pronounced “dahy-AL-uh-sis” “FIS-choo-luh”) is a minor surgical procedure that makes it easier to access your bloodstream for hemodialysis. A surgeon connects an artery to a vein, usually in your nondominant arm (the arm you don’t use to perform most tasks, like writing or throwing).

It’s the most popular type of hemodialysis access (dialysis port) because it’s the most efficient way for a healthcare provider to access your bloodstream. It’s also the least likely to cause problems, including blood clots and infection.

Another name for a dialysis fistula is an arteriovenous (AV) fistula. “Arterio” means artery, and “venous” means vein.

What does a dialysis fistula treat?

A dialysis fistula makes it easier for you to receive hemodialysis. You may need hemodialysis if you have kidney failure (end-stage renal disease or ESRD). Conditions like high blood pressure (hypertension), lupus and diabetes can lead to kidney failure.

Is a dialysis fistula a major surgery?

Dialysis fistula surgery isn’t a major procedure. It’s usually an outpatient procedure. That means you can leave the hospital on the same day as the procedure.

How should I prepare for a dialysis fistula?

Before AV dialysis fistula surgery, your surgeon will explain the procedure and ask for your consent. They’ll perform a physical exam to make sure you’re healthy enough for surgery. They’ll also ask questions about:

• Your health history
• Any prescription or over-the-counter (OTC) medications you’re taking, including herbal supplements (certain medications, such as blood thinners, can increase your risk of bleeding)
• Any allergies you have

Once they determine you’re healthy enough for surgery, they’ll perform an ultrasound on your arm to look at your veins. This helps them choose the best dialysis fistula technique.

In the days leading up to your surgery, a healthcare provider will give you specific directions on when to stop taking prescription or OTC medications, if necessary.

What are the different dialysis fistula techniques?

The most common dialysis fistula techniques include:

• Radiocephalic fistula. A radiocephalic (pronounced “RAY-dee-oh-SEH-fa-lick”) fistula connects your cephalic vein to your radial artery. Your cephalic vein is a large vein that runs along the outer edge of your biceps muscle. Your radial artery runs along the inside of your forearm from your elbow to your thumb.
• Brachiocephalic fistula. A brachiocephalic (pronounced “brah-KEE-oh-SEH-fa-lick”) fistula connects your cephalic vein to your brachial artery. Your brachial artery runs along the front of your biceps muscle.
• Transposed brachiobasilic fistula. A transposed brachiobasilic (pronounced “brah-KEE-oh-buh-SIL-ick”) fistula connects your brachial artery to your basilic vein. Your basilic vein runs from your hand up the inside of your arm to your elbow. Your surgeon will only use this technique if the other approaches aren’t possible.

What kind of surgeon performs dialysis fistula surgery?

A vascular surgeon performs AV dialysis fistula surgery. Vascular surgeons diagnose and treat conditions that affect your blood vessels, including arteries and veins.

What happens during a dialysis fistula?

During dialysis fistula surgery, your care team will:

• Give you a local anesthetic to numb your treatment area and a sedative through a peripheral IV to help you relax.
• Use a surgical knife (scalpel) to make a small cut (incision) in your treatment area — usually in your arm, with your elbow or wrist as the best locations.
• Clamp a small section of your artery.
• Use the scalpel to cut small areas of your artery and vein.
• Sew the vein into the clamped section of your artery.
• Release the clamps.
• Ensure blood flows through your vein and that there isn’t any bleeding.
• Close your incision with dissolvable stitches (sutures).

How long does a dialysis fistula take?

Dialysis fistula surgery usually takes one to two hours to complete.

What happens after a dialysis fistula?

An AV fistula must heal for at least a few months before it’s ready for hemodialysis. A healthcare provider may also recommend stress ball exercises to help strengthen and expand your fistula.

The fistula will look like a large vein under your skin. You should check your blood flow daily by feeling for a vibration, which may feel like a purring cat. Some describe the vibration as a buzz, pulse or trill. Once you heal, you should be ready for hemodialysis.

During hemodialysis, a hemodialysis nurse or technician will insert two needles in the “strike zone” of your engorged vein. One is an “arterial” (artery) needle that removes blood from your body and sends it to the hemodialysis machine. The machine then sends your clean blood back into your body through the second “venous” (vein) needle.

The needle in the arterial side removes blood from your body and sends it to a hemodialysis machine. The machine sends your clean blood back into your body through the needle in the venous side.

Is a dialysis fistula permanent?

A dialysis fistula isn’t usually permanent. But it can last for many years.

To help protect your fistula and make it last as long as possible, you should avoid:

• Sleeping on your access area
• Wearing tight clothing or jewelry that may squeeze the area
• Using a cuff on your affected arm to check your blood pressure
• Having blood drawn from your affected arm

It’s also a good idea to wear medical alert jewelry, like a bracelet or necklace, to inform providers about your dialysis fistula. You can also add emergency information on your smartphone’s lock screen. Some people also choose to get a medical alert tattoo on their arm.

What are the benefits of a dialysis fistula?

Benefits of an AV dialysis fistula include:

• It lasts longer than a dialysis graft. A dialysis graft uses a soft, hollow tube (graft) to join your artery and vein.
• It has a lower chance of developing blood clots or other blockages.
• It’s less likely to develop an infection.
• It supplies excellent blood flow once it heals.

What are the risks or complications of dialysis fistula?

Dialysis fistula risks include:

• Infections
• Enlargement of your vein or artery (aneurysm)
• Narrowing of your vein or artery (stenosis)
• Reduced blood flow in parts of your body (ischemia)
• Blood clots in your vein or artery (thrombosis)

What is the recovery time?

It takes at least a few months for your AV dialysis fistula to heal before you can start hemodialysis. But your body is unique. Your healing time may be shorter or longer. As you recover, a hemodialysis nurse will regularly check your fistula to make sure it’s getting larger and stronger. They’ll let you know once it fully heals and is capable of supporting dialysis needles.

How long do dialysis fistulas last?

In most cases and with proper care, a dialysis fistula can last for years or even decades.

When should I call a healthcare provider?

Call your healthcare provider if you don’t feel a vibration in your dialysis fistula when you check your blood flow or if you think you damaged your fistula.

Why do dialysis fistulas get so big?

As your dialysis fistula heals, it’ll get larger to allow for a faster blood flow.

Can kidneys start working again after dialysis?

No, chronic kidney damage can’t heal after dialysis. A kidney transplant is the only way to stop receiving dialysis safely.

What is the life expectancy of a fistula patient?

If you’re on hemodialysis, the average life expectancy is between five and 10 years. A healthcare provider will give you a better idea of what to expect based on your specific situation.