AV Fistula Surgery in Delhi

Indications

AV fistula surgery is indicated for:

• Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) who require hemodialysis.
• Patients who need long-term vascular access for treatments such as chemotherapy or other infusion therapies.

Types of AV Fistulas

• Radiocephalic Fistula: Created at the wrist by connecting the radial artery to the cephalic vein.
• Brachiocephalic Fistula: Created at the elbow by connecting the brachial artery to the cephalic vein.
• Basilic Vein Transposition: The basilic vein is connected to the brachial artery, often requiring the vein to be moved to a more superficial location.

Preoperative Preparation

1. Medical Evaluation:
   • Thorough medical history and physical examination.
   • Assessment of the patient’s vascular system using ultrasound or other imaging studies to select the best site for the fistula.
2. Patient Education:
   • Discuss the benefits, risks, and care of the AV fistula.
   • Instructions on how to prepare for the surgery, including fasting guidelines and medication adjustments.
3. Laboratory Tests:
   • Blood tests to evaluate the patient’s overall health and readiness for surgery.

Procedure Steps

1. Anesthesia:
   • Local anesthesia is commonly used, though regional or general anesthesia may be used depending on patient needs and surgeon preference.
2. Incision and Vessel Preparation:
   • A small incision is made at the chosen site (wrist or elbow).
   • The selected artery and vein are identified and prepared for connection.
3. Creating the Fistula:
   • The artery and vein are connected directly using sutures, creating a fistula that allows arterial blood to flow directly into the vein.
   • This increased blood flow causes the vein to enlarge and thicken, making it suitable for repeated needle insertions for dialysis.
4. Closure:
   • The incision is closed with sutures or staples.
   • A sterile dressing is applied to the surgical site.

Postoperative Care

1. Monitoring:
   • Patients are monitored for any immediate complications, such as bleeding or infection.
   • The fistula is checked for proper blood flow, usually using a stethoscope to listen for a “thrill” (a vibrating sensation) or a “bruit” (a whooshing sound).
2. Pain Management:
   • Pain is managed with over-the-counter pain relievers or prescribed medications as needed.
3. Wound Care:
   • Instructions on keeping the surgical site clean and dry.
   • Guidelines on when to change dressings and how to identify signs of infection.
4. Activity Restrictions:
   • Avoid heavy lifting and strenuous activities with the affected arm until cleared by the healthcare provider.
   • Elevate the arm to reduce swelling and promote healing.
5. Follow-Up:
   • Regular follow-up appointments to monitor the maturation of the fistula, which can take several weeks to months.
   • Imaging studies or physical examinations to ensure the fistula is developing properly and is ready for use.

Complications

While AV fistula surgery is generally safe, potential complications include:

• Infection: Risk of infection at the surgical site or in the fistula.
• Bleeding: Risk of bleeding during or after the procedure.
• Thrombosis: Blood clots forming in the fistula, which can block blood flow.
• Aneurysm Formation: Swelling or bulging in the vein due to the increased blood flow.
• Steal Syndrome: Reduced blood flow to the hand due to the diversion of blood through the fistula.

Conclusion

AV fistula surgery is a crucial procedure for patients requiring long-term hemodialysis, providing a reliable and durable vascular access. Proper preoperative preparation, skilled surgical technique, and attentive postoperative care are essential for the successful creation and maintenance of an AV fistula. Regular follow-up with healthcare providers ensures the fistula is functioning correctly and allows for timely intervention if complications arise.