Our Summary

This paper is about a procedure called dialysis fistula creation, which is often carried out on patients with severe kidney disease who need long-term dialysis. The ideal dialysis fistula lets a lot of blood flow through it for effective dialysis, can be used multiple times, and lasts a long time with few complications. In the US, over 400,000 patients receive dialysis, and Medicare spends around $90,000 per patient, per year on their treatment.

The paper talks about the various techniques for creating a permanent dialysis access, with arteriovenous fistulas (AVFs) shown to have the best clinical and economic benefits. National guidelines recommend using AVFs as the first choice for dialysis access in patients with severe kidney disease, followed by prosthetic grafts and then dialysis catheters.

Research has shown that AVFs lead to a significant reduction in infections, hospitalizations, catheter failure, vein narrowing, and death, as well as overall cost, compared to prosthetic grafts or dialysis catheters. Although AVFs take longer to prepare for use, they last from 3 to 5 years, compared to 1 to 2 years for AV grafts.

Finally, the article will go into detail about the anatomy involved, the reasons for doing the procedure, any reasons not to do it, the procedure details, and any complications associated with creating an arteriovenous dialysis fistula.

FAQs

  1. What is a dialysis fistula and why is it important for patients with severe kidney disease?
  2. What are the advantages of using arteriovenous fistulas (AVFs) over prosthetic grafts and dialysis catheters for dialysis access?
  3. What are the potential complications associated with creating an arteriovenous dialysis fistula?

Doctor’s Tip

One helpful tip a doctor might tell a patient about AV fistula creation is to carefully follow post-operative care instructions to ensure proper healing and function of the fistula. This may include keeping the area clean and dry, avoiding heavy lifting or strenuous activity with the affected arm, and monitoring for any signs of infection or complications. It is important to communicate any concerns or changes in the fistula to your healthcare provider to address any issues promptly.

Suitable For

Patients who are typically recommended AV fistula creation are those with severe kidney disease who require long-term dialysis. This includes patients who have end-stage renal disease and need hemodialysis to filter waste and excess fluid from their blood. AV fistulas are recommended as the first choice for dialysis access due to their superior clinical and economic benefits compared to other options such as prosthetic grafts or dialysis catheters. AV fistulas have been shown to reduce infections, hospitalizations, catheter failure, vein narrowing, and death, leading to overall cost savings in the long run.

It is important to consider the patient’s individual anatomy, overall health, and readiness for dialysis before recommending AV fistula creation. Patients with suitable veins and arteries for the procedure, as well as those who are committed to long-term dialysis treatment, are good candidates for AV fistula creation. However, patients with certain medical conditions or anatomical issues may not be suitable candidates for AV fistula creation and may need alternative dialysis access options.

Timeline

Before AV fistula creation:

  • Patient is diagnosed with severe kidney disease and is recommended to undergo long-term dialysis
  • Patient undergoes various tests and evaluations to determine the best treatment plan
  • Doctor recommends AV fistula creation as the preferred method of dialysis access
  • Patient receives counseling and education about the procedure and what to expect

After AV fistula creation:

  • Patient undergoes the surgical procedure to create the AV fistula
  • Recovery period following the surgery, which may include pain, swelling, and limited arm movement
  • Follow-up appointments to monitor the healing of the fistula and assess its function
  • Once the fistula is matured and ready for use, patient begins dialysis treatment through the AV fistula
  • Patient experiences improved dialysis outcomes, reduced risk of complications, and increased quality of life due to the successful AV fistula creation.

What to Ask Your Doctor

Some questions a patient should ask their doctor about AV fistula creation include:

  1. What is an AV fistula and why is it the recommended choice for dialysis access?
  2. What are the benefits of having an AV fistula compared to other types of dialysis access?
  3. What is involved in the procedure to create an AV fistula?
  4. How long does it typically take for an AV fistula to be ready for use?
  5. What are the potential complications associated with AV fistula creation?
  6. How long can I expect an AV fistula to last?
  7. Are there any reasons why I may not be a good candidate for an AV fistula?
  8. What can I do to take care of my AV fistula and prevent complications?
  9. How often will I need to have my AV fistula checked by a healthcare provider?
  10. Are there any lifestyle changes I should make after having an AV fistula created?

Reference

Authors: Marsh AM, Genova R, Buicko Lopez JL. Journal: 2023 May 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32644511