An arteriovenous (AV) fistula connects an artery to a vein in your arm. This provides a stronger access point for the needles from a hemodialysis machine.

If you have end stage kidney disease (ESKD), also called end stage renal disease, your kidneys may no longer be able to filter out toxins from your blood. More than two-thirds of people with ESKD in the United States use dialysis to help them with this filtering process.

Dialysis performs the same function that your kidneys usually would — preventing toxins from accumulating in your blood and damaging other organs. The toxins can then move to your bladder and leave your body when you urinate. The most common type of dialysis is hemodialysis, which uses a hemodialyzer filtering machine.

The preferred method for providing an entry point in the blood vessels for hemodialysis is creating an arteriovenous (AV) fistula. A fistula is a connection between two body parts that are not typically connected. To create an AV fistula, a surgeon connects an artery to a vein in your arm.

Keep reading to learn more about AV fistulas and the procedure for creating them.

At the beginning of a dialysis session, two needles connected to tubes from a hemodialyzer are placed in your AV fistula.

During dialysis, your blood travels through one of the tubes to the hemodialyzer. Your cleansed blood returns to your body through the other tube.

An AV fistula causes more blood to flow through your vein. This enlarges and thickens your vein so it becomes strong enough to endure ongoing needle insertions for your dialysis sessions.

The larger diameter of the fistula also allows your blood to flow more quickly to and from the dialyzer, so more of your blood can be cleansed.

Without an AV fistula, your vein could collapse and dialysis would not be possible.

Types of fistulas for dialysis

The types of AV fistula for dialysis include:

Doctors may create a brachiocephalic or transposed brachiobasilic fistula if a radiocephalic fistula isn’t an option.

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A surgeon usually creates an AV fistula at least 6 weeks before your first dialysis session to allow time for your vein to become enlarged.

You may receive local anesthesia to numb the area of your arm where the fistula will be created or general anesthesia so you’re not awake during the procedure.

You can usually go home afterward.

An AV fistula is the preferred type of access for hemodialysis because it generally has a lower risk of complications and infections than a graft or catheter.

However, an AV fistula may not be possible if your vein is damaged and has scar tissue due to repeated needle insertions for blood work, medications, or other reasons.

Possible complications of AV fistula surgery include:

  • Thrombosis: The most common complication is the formation of a blood clot caused by the narrowing of your vein.
  • Infection: A 2017 research review found that infections were the second most common complication.
  • Aneurysm: A bulge in your artery may develop due to repeated needle insertions.
  • Dialysis-associated steal syndrome: This complication, which occurs in up to 8% of people with AV fistulas, causes reduced or reversed blood flow to your hand.
  • Failure to mature: The fistula may become unusable due to factors such as a narrowing of the blood vessels leading to low blood flow or the formation of blood clots.
When to contact a doctor

Contact a doctor or your dialysis center immediately if you experience any of these symptoms around your fistula:

  • redness, swelling, or soreness
  • bleeding that lasts longer than 20 minutes after the end of your dialysis session
  • numbness, tingling, or a cold feeling in your arm

Protect the arm in which the fistula will be created by doing the following:

  • Don’t allow injections in that arm.
  • Don’t have blood drawn from that arm.
  • Don’t use a cuff to take your blood pressure on that arm.

Rather than creating a fistula, healthcare professionals can join your blood vessels with a graft (a soft tube) or a catheter (a tube that’s usually inserted into a large vein in your neck).

According to data from the National Institute of Diabetes and Digestive and Kidney Diseases, in 2021, 12.2% of people used an AV fistula as an entry point, while 85.4% used a catheter.

A 2018 study suggests that AV fistulas last longer and have a lower risk of infections than either grafts or catheters.

The following are the answers to some frequently asked questions about AV fistula surgery.

How long is fistula surgery for dialysis?

The surgery to create an AV fistula usually takes about 1 hour.

Is fistula surgery for dialysis painful?

A healthcare professional will usually give you local anesthesia to numb your arm so you feel no pain. You might receive general anesthesia so you’re not awake during the surgery.

How long do dialysis fistulas last?

An AV fistula will last for many years, according to the National Kidney Foundation. A 2019 Thai study of 290 people suggests that the average survival rate for an AV radiocephalic or brachiocephalic fistula is 3.1 years.

The researchers noted certain factors that may lower the survival rate: age of 65 years or older, diabetes, and prior catheter placement.

Can a dialysis fistula be removed?

Doctors can surgically remove an AV fistula if it’s causing complications or for cosmetic reasons. There are usually few complications with this procedure.

An AV fistula connects an artery to a vein in your arm to provide a stronger entry point for the needles necessary for hemodialysis. It generally has fewer complications than entry points created with a catheter or graft.

The surgery to create an AV fistula takes about an hour, but you must then wait several weeks to allow your vein to enlarge before you start dialysis.

An AV fistula may not be an option if there’s damage to the veins in your arm. You can talk with your doctor about the type of dialysis entry point that’s best for you.