Description Dialysis access surgery is a term used to describe procedures performed to allow patients with renal failure a way to undergo hemodialysis. Hemodialysis is a treatment that “cleans out” the blood similar to what the kidneys normally do. Because of the long-term need (up to years) and frequent need (three time a week) for hemodialysis a durable way, or “access,” to a patient’s bloodstream is required. This solution is to create a direct connection between a high-flow artery and a vein that can be accessed with IV needles. This connection is usually created in the arm and can be of two types: a “fistula” is when an artery is directly sewn to a vein, and a “graft” is when the artery is sewn to a synthetic tube and the tube is placed under the skin, like a vein, and the other end is sewn to a vein. There are many reasons for choosing one type of procedure over the other that are unique to each individual patient, your surgeon will conduct some tests to see which is best for you.
This is usually the first line test to evaluate a patient to find out if they have adequate arteries and veins for placement of either a fistula or graft. Both arms are “mapped” to show where the veins lie and whether they are healthy, branched, or open.
Venography may be used to image the arm veins and the more central veins under the ribs and collarbone that an ultrasound can’t see. This test may be necessary if abnormal flow through the more central veins seems to be present which can impact whether or not a fistula or graft will work properly.
A primary arteriovenous fistula, connects your vein to your artery is the first choice for this procedure. However, if you do not have adequate veins that can be used for surgery, a graft AVF is necessary. A graft AVF is a synthetic piece of tubing that is used in place of your own vein.
Placement of an arteriovenous fistula or arteriovenous graft is typically an in-and-out type of surgery not requiring overnight stay in a hospital. It can be done under general anesthesia, local anesthesia at the incision site, or anesthesia that numbs the entire arm. Afterwards there will be a new vibration sensation, or ”thrill”, over the graft and possibly some swelling that should subside. You will then have frequent follow-up checks to make sure the fistula or graft is working properly.
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