Arteriovenous fistulas for dialysis
Haemodialysis requires a vascular access that allows blood to be removed and returned at a high flow rate several times a week. The best access is the one tailored to each patient, their veins and their kidney treatment plan.
Types of vascular access
Native arteriovenous fistulaA connection between the patient’s own artery and vein, usually in the arm. It is the access with the fewest infections and the longest lifespan, but it needs a few weeks to “mature” before it can be used.
Graft fistulaConnects an artery and a vein through a prosthetic tube. It can be used sooner, but carries a higher risk of thrombosis and infection.
Central venous catheterUsed when there is no other option or while a fistula matures. It carries a higher risk of infection and of damaging the central veins.
A tailored plan
The 2019 KDOQI vascular access guideline proposes moving from the “fistula first” motto to an individualised life plan for each person with kidney disease: choosing the access according to their age, veins, prognosis and preferences, and planning the next accesses. The European guidelines (ESVS 2018) recommend assessing veins and arteries with duplex ultrasound before surgery and, whenever possible, starting at the most distal sites of the arm to preserve future options.
What we offer
- Duplex ultrasound assessment and access planning, in coordination with nephrology.
- All types of native and graft fistulas.
- Treatment of complications: stenosis, thrombosis, fistula aneurysms or steal syndrome (poor blood supply to the hand).
- Solutions for complex cases: the HeRO graft for patients with occluded central veins.
Caring for your fistula
- Check every day that you can feel the “buzz” or vibration (thrill).
- Do not have your blood pressure taken or blood drawn from that arm.
- Avoid tight clothing, watches or bracelets that compress it, and do not sleep on that arm.
- Keep good hygiene and seek advice if you notice pain, redness, a cold hand or if the buzz can no longer be felt.
References
- Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1-S164.
- Schmidli J, Widmer MK, Basile C, et al. Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757-818.
Patient information reviewed by Dr Óscar Merino, vascular surgeon. It does not replace an individual medical assessment.
Would you like an assessment?
Consultation with duplex ultrasound at Clínica Rotger, in the centre of Palma.
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