Saturday, January 23, 2021

AV Fistula on Dialysis: Don't give up too easily

An Arteriovenous Fistula (AVF) is the Gold Standard for accesses in Hemodialysis. A surgeon or a doctor will connect an artery and a vein underneath the skin to improve the pressure of the blood in the vein to enable good flow rates for hemodialysis. Other types of hemodialysis accesses in decreasing order of preference are an Arteriovenous Graft (AVG), a Tunnelled Catheter, and a Non-Tunnelled Catheter. The last two are also called Permanent Catheter and Temporary Catheter, respectively. 
The advantage of an AVF is that it is completely inside the body with no exposed portion, reducing the risk of an access infection dramatically. That is why clinically AVFs are the best type of access for hemodialysis. Many patients have AVFs that last for decades with no problems.

AVFs give some problems from time to time in some patients. These could range from poor flow, obstruction in the vein and infections, etc. There is a worrying trend among some people to abandon a problematic AVF and construct a new one. This is not the right approach as per experts.

The human body has only a few sites where an AVF can be constructed. Of these also, only four are most comfortable and convenient from the patient's perspective. Also, once an AVF site has been abandoned, it is impossible to use it again to create another AVF. So, you have only four attempts at convenient AVFs.

So use them judiciously.

What then should one do if an AVF gives a problem? Do everything you can to repair it. Talk to your nephrologist. Go to the best vascular surgeon in your city. Ask them to examine it and try their best to repair it. Do not give up easily.

There are several things that can be done to repair an AVF. A venogram will tell them what is wrong. A fistuloplasty (a balloon angioplasty of the vein connected to an AVF) will open up obstructions. A stent can open up obstructions in the vein more long-term. All these procedures are like maintenance for the plumbing of the body. We cannot do without them, and if we ignore them, they can lead to more severe problems.

Some of these procedures are expensive. However, in the long run, this would be an investment worth making.

So, please don't give up at the slightest hint of a problem with your AVF. Do all you can to repair and revive it. Remember, you have limited options with AVFs.


Shreyas said...

Dear Kamal Sir,

If you can throw some light on basilic vein transposition? I have seen vascular surgeon recommending for the ones with damaged AVF.

Unknown said...

Dear Mr. Kamal, very interesting article.

Reg. Medical topics, Can you share the details of 4 points where AVF can potentially be explored, as referred in the article? Can you also advise the success rate for AVF in general, based on your experience/observation.

Referring to mental well-being,

Can you share your experience on how you dealt with the Dialysis situations? Specifically making decisions on changing from one type of Dialysis to another type (i.e. from AVF to HD to PD)

This will very helpful for people who get mentally affected due to Dialysis

Kamal D Shah said...

Dear Shreyas, I have no idea about this. Sorry!

Kamal D Shah said...

Dear Unknown, 4 points are near the wrist and the elbow of the right and left arms.

About changing from one type top the other type of dialysis, that is quite a large topic and difficult to cover in a single comment of a blog. But the main thing is to see what options are available that give you the desired quality of life. And then the rest follows pretty straightforwardly from there.