Dialysis Access Creation

Arteriovenous Fistula (AV Fistula)

• An AVF is considered currently the gold standard for vascular access for haemodialysis. This is basically a surgical connection between an artery and a vein, more commonly performed in the forearm/arm region or if those sites are exhausted, in the thigh area. It is the preferred access creation because it can usually last for a longer time than an artificial graft or catheter tube and is less susceptible to infection because no foreign material is used as the conduit. It is created by stitching an artery and a vein together, usually in the non-dominant arm in either the wrist, forearm or elbow areas.
• An AVF creation results in an increased blood flow rate through the vein, which helps enlarge and strengthen the vein. An AV fistula allows a higher rate of blood to flow back and forth from your vein to a dialysis machine for efficient blood cleaning.
• The AVF may take up to 2-3 months to mature and become functional, especially if the vein and artery are small to start with. Generally, an AVF has fewer complications than AVG especially in Singapore. An AVF is usually created as a day surgery procedure under local anaesthesia.

Advantages

• Can function for years if well taken of
• Not as likely as a catheter to become infected
• Not as likely to clot than an AVG

Disadvantages

• May require another temporary type of access during the healing and maturation phase such as a CVC
• Maturation may be delayed, or it may fail to mature
• Needles are required to access the AV fistula for haemodialysis usually 2-3 times per week
• The AVF may need servicing from time to time, because the needling process can cause trauma and scarring to the vein with continued use causing narrowing and potential blockage.