Arterio-Venous Fistula Formation
An arterio-venous fistula is an artificial connection made between and artery and a vein, usually in the arm. This may be made by linking a vein directly to an artery. Alternatively, it made be made utilizing a synthetic conduit joined to the artery at one end and to the vein at the other. By linking the artery directly to the vein it increases the flow and pressure in the vein allowing it to be used for dialysis.
The operation may be performed under local or general anaesthetic. After the anaesthetic, the area is prepared with a sterile solution to sterilize the skin before the incision. Through the incision the artery and vein are dissected free. If a prosthetic conduit is to be utilized, then it is passed through a subcutaneous tunnel. Blood thinner is given before the vessels are clamped. Once the vessels are clamped, the vein is anastomosed to the artery or the prosthetic conduit is anastomosed to the artery and vein.
The area is checked for bleeding and then the wounds are closed in layers.
Several complications are possible. These include anaesthetic risks including (death, stroke and heart attack), infection, bleeding, failure, and others. As these are abnormal connections, and a proportion fail, either immediately or at a later point. Alternatively, too much blood may flow through the fistula stealing blood from the hand – ‘steal’ syndrome. This can cause pain, gangrenous spots or even digital loss. Some of the complications listed may need further surgery to correct them.