Arteriovenous Fistula/ AV fistula

An arteriovenous fistula is a surgical connection between an artery and a vein that provides reliable, long-term access for hemodialysis treatments. By creating a robust pathway for blood flow, this procedure helps ensure efficient toxin removal and reduces complications associated with temporary access methods.

What is an Arteriovenous Fistula or AV Fistula?

An arteriovenous fistula (AVF), also known as an arteriovenous anastomosis, is a surgically created connection between an artery and a vein, most commonly in the arm, that produces a high-flow vessel ideally suited for repeated access. Unlike temporary catheters, an AVF uses your blood vessels to establish a durable lifeline for hemodialysis.

AVFs are the preferred option for people with end-stage kidney disease or advanced chronic kidney disease who require long-term hemodialysis. Because the vein walls need to thicken and expand, a process called maturation, AVFs are planned several weeks before starting dialysis to ensure patients have the safest and most effective access in place when treatment begins.
 

How an AV Fistula Works

During the AVF surgery, your vascular surgeon creates the anastomosis by sewing a section of an artery directly into a nearby vein. Rerouting arterial pressure into the vein stimulates the vein walls to thicken and the vessel to enlarge over six to eight weeks. 

As the vein matures, it becomes robust enough to withstand the repeated needle insertions required for hemodialysis. The resulting high-flow access improves the clearance of toxins and excess fluid while reducing the risks of infection and clotting compared to temporary catheter methods.
 

Types of AVF Revision Procedures

• Angioplasty: A balloon-tipped catheter is inserted to widen narrowed (stenotic) areas of the fistula, improving blood flow.
• Thrombectomy: This procedure removes blood clots (thrombus) from the fistula using mechanical devices or medications to restore flow.
• Stent Placement: A small mesh tube (stent) is placed in weakened or re-narrowed areas to keep the vessel open and prevent collapse.
• Aneurysm Repair: Bulging sections of the fistula may be reinforced, revised or partially removed to prevent rupture or access failure.
• Banding or Flow Reduction: Used when blood flow through the fistula is too high, causing complications like heart strain or hand ischemia. The vessel is narrowed to reduce flow to safe levels.
• Outflow or Inflow Revision: Surgeons may re-route or reconstruct parts of the fistula if the original vessel develops scarring or fails to mature properly.
• Conversion to a Graft: In some cases, a fistula may be converted to a graft by inserting a synthetic tube to bridge blocked or damaged areas.

What to Expect When You Have an Arteriovenous Fistula AVF 

Once your fistula is in place and fully matured, you’ll use it for each hemodialysis session. Before treatment, your dialysis team will check for proper blood flow by feeling the fistula and listening for its steady humming vibration. 

Between sessions, plan to wash the area daily, keeping the skin around your fistula clean and free of lotions or creams. You’ll also routinely check for any changes, such as swelling, firmness or prolonged bleeding after needle removal, and report concerns promptly. 

Your care team will schedule regular access evaluations, which may include physical exams and ultrasound checks, to monitor fistula health. With good daily care and these periodic assessments, your AVF can remain a reliable, long-term access point for dialysis.