AV fistula

1. AV Fistula

An **arteriovenous fistula** (AV fistula) is an abnormal connection or passageway between an artery and a vein. It is often surgically created for use in hemodialysis treatment for patients with chronic kidney disease. This article provides an overview of AV fistulas, their creation, uses, and potential complications.

Overview

An AV fistula is a direct connection between an artery and a vein, typically in the arm. This connection allows for increased blood flow through the vein, which causes the vein to enlarge and its walls to thicken. This process, known as "maturation," makes the vein suitable for repeated needle insertions required for hemodialysis.

Creation of an AV Fistula

The creation of an AV fistula is a surgical procedure usually performed by a vascular surgeon. The most common site for an AV fistula is the forearm, where the radial artery is connected to the cephalic vein. This is known as a "radiocephalic fistula." Another common site is the upper arm, where the brachial artery is connected to the cephalic vein, known as a "brachiocephalic fistula."

Procedure

1. **Preoperative Assessment**: Before the procedure, the patient's veins and arteries are assessed using ultrasound to ensure they are suitable for fistula creation. 2. **Surgical Technique**: Under local or general anesthesia, the surgeon makes an incision to access the selected artery and vein. The artery and vein are then connected using sutures. 3. **Postoperative Care**: After surgery, the fistula is allowed to mature over several weeks to months before it can be used for dialysis.

Uses in Hemodialysis

AV fistulas are considered the "gold standard" for vascular access in hemodialysis due to their longevity and lower complication rates compared to other access types like central venous catheters or AV grafts.

Complications

While AV fistulas are generally safe, they can be associated with several complications:

• **Thrombosis**: Blood clots can form in the fistula, leading to blockage.
• **Infection**: Although less common than with catheters, infections can occur.
• **Steal Syndrome**: This occurs when too much blood is diverted from the hand, leading to ischemia.
• **Aneurysm Formation**: The vein can become dilated and form an aneurysm.

Also see

• Hemodialysis
• Chronic kidney disease
• Vascular surgery
• Central venous catheter
• AV graft

Resources

Latest articles - AV fistula

• Most recent articles
• Ongoing trials

Source: Data courtesy of the U.S. National Library of Medicine. Since the data might have changed, please query MeSH on AV fistula for any updates.

‎