AV Fistula Creation for Dialysis

If your kidney function is sliding towards dialysis, one of the most useful things you can do now has little to do with your kidneys. It is protecting the veins in one arm and getting a fistula made in good time, months before you need it.

An arteriovenous (AV) fistula is a direct connection, made by a surgeon, between an artery and a vein, usually at the wrist or elbow of the arm you don't write with. Blood from the artery rushes into the vein at high pressure. Over the following weeks the vein's wall thickens and the vein widens, until it can take two dialysis needles three times a week and deliver the fast flow a dialysis machine needs. You can feel it under the skin as a buzz, called the thrill.

A fistula uses only your own blood vessels, so it clots and gets infected less often than a plastic graft or a neck catheter, and a good one can last many years. The catch is time. Most fistulas need 6 to 8 weeks, often longer, before they can be used. Some never mature enough, particularly in older people, people with diabetes and those with small veins, and need a second procedure or a new fistula higher up the arm.

Our nephrologists talk through dialysis options early with people approaching end-stage kidney disease, which leaves time to plan access before dialysis becomes urgent. Once your fistula is ready, it's used for haemodialysis in our dialysis unit, where trained nephrology nurses check it at every session and a nephrologist reviews you each time.

A fistula is the first-choice access for almost everyone starting long-term haemodialysis.

The wound heals in about 2 weeks. The fistula takes longer to become usable, and a few daily habits help it along.