AV Fistula
POSTED BY Dr. Sumit Kapadia | May 04, 2023

What is an AV Fistula and Why is it considered a lifeline for Dialysis Patients?

For patients with kidney disease, hemodialysis is often necessary to remove excess waste and fluids from the body. However, frequent access to the bloodstream is necessary for this process to occur. One way to achieve this access is through an arteriovenous (AV) fistula. This article will discuss the importance of AV fistulas for dialysis patients, what they are, who can do them, and why they are essential.

What is AV Fistula?

An AV fistula is created through a surgical procedure in which an artery and vein in the forearm are connected by microsurgical stitches. The surgeon creates a small incision in the skin and attaches the artery and vein together, creating the AV fistula. Over time, the vein becomes larger and stronger due to the fast flow, making it easier to insert needles for hemodialysis treatments.

Importance of AV Fistula in Dialysis Patients

An AV fistula is the preferred method of access for hemodialysis. It is important because it provides a direct connection between an artery and vein in the forearm, allowing blood to flow from the artery to the vein. This connection creates a larger blood vessel with increased blood flow, making it easier to insert needles for dialysis treatments.

A functioning AV fistula can reduce complications such as infection, bleeding, and clotting, which can occur with other access methods such as catheters or AV grafts. Additionally, an AV fistula is more durable than other methods, meaning it can last longer, reducing the need for frequent interventions and surgeries.

AV Fistula for Dialysis

AV fistulas provide a reliable and durable access for hemodialysis, reducing the risks of complications and improving patient outcomes. Additionally, AV fistulas allow for higher blood flow rates, making dialysis treatments more efficient and effective. Patients who have AV fistulas are less likely to experience complications such as infections and blood clots, which can lead to hospitalizations and other health issues.

Advantage of AV Fistula in Dialysis Patients

AV fistulas offer several advantages for dialysis patients over other access methods, such as catheters or AV grafts. Some of these advantages include:

Lower Risk of Infection: AV fistulas have a lower risk of infection compared to catheters, which require a small plastic tube to be inserted into a vein. This tube can increase the risk of infection and can be difficult to clean properly.

Lower Risk of Clotting: AV fistulas have a lower risk of clotting than AV grafts, which are synthetic tubes that are used to connect an artery and vein. Clotting can lead to complications such as decreased blood flow and can require additional procedures to fix.

Increased Durability: AV fistulas are more durable than catheters and AV grafts. They are less likely to require additional surgeries or interventions, and they can last for many years with proper care.

Higher Blood Flow Rates: AV fistulas provide higher blood flow rates than other access methods, which can make dialysis treatments more efficient and effective. This can also reduce the amount of time patients need to spend in treatment.

Overall, AV fistulas are the preferred method of access for dialysis patients because they offer several advantages over other methods. They reduce the risk of complications, improve patient outcomes, and allow for more efficient and effective dialysis treatments.

How is an AV Fistula surgery performed

AV fistula surgery is performed in a hospital by a qualified vascular surgeon. Although many doctors would perform a surgery, vascular surgeons would be able to deliver better results as they can do a doppler mapping to identify the best site and also are well trained in handling of blood vessels. The surgery typically takes 1-2 hours, and the patient will be given local anesthesia to numb the area.

The surgeon will first locate a suitable artery and vein in the forearm. They will then create a small incision in the skin over these vessels and connect the artery to the vein using a surgical technique that varies depending on the surgeon’s preference and the patient’s anatomy.

Once the connection is made, blood flow through the vein will increase, causing the vein to become larger and stronger. This process, called maturation, can take several weeks to several months, during which time the patient may need to avoid heavy lifting or other activities that could damage the fistula.

After the fistula has matured, the patient can begin using it for hemodialysis. During dialysis treatments, needles will be inserted into the fistula to allow blood to flow out of the body, be filtered through the dialysis machine, and then returned to the body through the fistula.

Patients who undergo AV fistula surgery will need to follow a care plan that includes keeping the area clean and dry, avoiding tight clothing or jewelry that could compress the fistula, and monitoring for signs of infection or other complications. With proper care, AV fistulas can last for many years and provide reliable access for dialysis treatments.

Who can do AV Fistula Surgery for Dialysis Patients?

A vascular surgeon typically performs the procedure to create an AV fistula. However, before the surgery, patients may undergo a vascular assessment to determine if an AV fistula is possible. This assessment may involve ultrasound or other imaging studies to evaluate the veins and arteries in the forearm.

Dr. Sumit Kapadia is a renowned Senior Vascular & Endovascular and Varicose Vein Surgeon who has extensive experience in performing AV fistula surgery for dialysis patients. As a vascular surgeon, Dr. Kapadia has specialized knowledge and skills in diagnosing and treating conditions that affect the blood vessels, including those that can impact the creation and maintenance of AV fistulas.

Dr. Kapadia can help dialysis patients who need an AV fistula by providing a thorough evaluation to determine the best approach for creating the fistula based on their individual anatomy and medical history. He can also provide guidance and support throughout the fistula creation process, including preoperative preparation, the surgical procedure itself, and postoperative care. Even for patients who have had previously failed AV fistula or poor sized veins, Dr Sumit has an extensive experience in performing complex procedures like basilic vein transposition and complex AV fistula or grafts.

In addition, Dr. Kapadia can help patients who are experiencing complications related to their AV fistula, such as infection or clotting, by providing prompt and effective treatment to prevent further problems and preserve the function of the fistula. Such endovascular procedures or dialysis access angioplasty ( also called Fistula Angioplasty) have been proven to be very helpful in prolonging the life of these important lifelines of dialysis patients. Our centre Aadicura in Vadodara is recognized as one of Western India’s top most centres of excellence in dialysis access procedures.

Dr. Kapadia’s expertise in vascular surgery and his commitment to providing compassionate, patient-centered care make him an excellent choice for dialysis patients who need AV fistula surgery or related services.


AV fistulas are essential for patients undergoing hemodialysis, providing a reliable and durable access for treatments. They reduce the risks of complications, improve patient outcomes, and allow for higher blood flow rates during dialysis. A vascular surgeon typically performs the surgery to create an AV fistula, and patients may undergo a vascular assessment before the procedure to ensure they are good candidates. For patients with kidney disease, an AV fistula is an important part of their treatment plan, and healthcare providers should prioritize its use whenever possible.