Breast Cancer FAQ

Understanding Dialysis Access: FAQ

What is an arteriovenous fistula and why do I need it for dialysis?

An arteriovenous (AV) fistula simply means a vein and an artery are connected to one another. It is formed, usually in your arm, when a vein and an artery are surgically sewn together to create a dialysis access. An AV Fistula is the best option for accessing your blood stream for hemodialysis treatments on an ongoing basis.

Arteries carry blood from the heart, while veins take blood back to the heart. Veins and arteries are actually quite different from one another, since they were designed for different work in the body. When a vein is connected to an artery, it takes on the pressure an artery routinely feels as blood is pushed out from the heart through the arteries and to surrounding tissues. This pressure allows the vein to mature, which is another way of saying it makes the vein wall stronger and the entire vein larger in size. This transformation of the vein allows it to be used as a long-term option. The process is referred to as "fistula maturation."

Why is a fistula preferred over a catheter for dialysis?

AV Fistulas are preferred by doctors over catheters for several reasons.

  • Catheters can cause serious infections when left in for a long time.
  • Catheters can create scar tissue inside the vein when left in for a long time. This can cause issues resulting in swelling of the neck, arms and face in addition to other symptoms. Scar tissue formation can also make it difficult to use an AV Fistula for hemodialysis treatments in the future.

AV Fistulas allow for a higher quality dialysis treatment and are regarded as the gold standard for hemodialysis access.

How soon can they use my fistula?

It's going to be at least 2-3 months before your fistula can be used for dialysis. The reason for this is that the vein needs some time to become strong enough and large enough to be accessed without damaging the fistula or causing undo discomfort related to the technical difficulty of trying to access a vein that is still too small. Because of the time it takes for a vein to mature, we recommend creating the AV Fistula before you actually need to begin treatments so it's ready to go when the time comes.

If you needed to have a catheter placed to allow the AV fistula time to mature, you will need to use the AV Fistula successfully for several weeks before we can remove the catheter.

Why should I have my fistula checked regularly?

We have found that regularly performing physical exams with a simple dye test called a fistulogram to see how the vein is working on the inside of your body can make your fistula last longer and help you to receive high quality uninterrupted dialysis treatments. We usually recommend seeing you back in 6 weeks if your fistula needed to be worked on but if you're not having any issues, we recommend having it checked every 3-6 months depending upon they type of fistula you have and other factors.

Getting you in for a routine check can help to prevent your AV Fistula from "clotting" or "going down." When this happens, a surgical procedure with anesthesia at the hospital is often required to repair your AV Fistula or to create a new one. Depending upon your situation, you may also need to have a temporary catheter placed in your chest while the AV fistula heals or a new AV fistula matures. We want to help you avoid this type of situation by managing your AV Fistula before issues arise.

What should I expect when I come in for a routine fistulogram?

You should expect to interact with experts who have years of experience in working with patients just like you and understand the importance of your AV Fistula! You can plan for your appointment to take around 30 minutes and there are usually no eating, drinking or driving restrictions before or after your appointment. We try to schedule these appointments on your non-dialysis day so there is no interruption to your normal dialysis schedule and you can go to dialysis immediately after your procedure with no problems.

Before the procedure, your surgeon will look at and feel your AV Fistula and talk to you about any issues you are having with it at dialysis. They want to know if you are having any limb swelling, bleeding longer than normal after a treatment, if they are having a hard time getting into the fistula at dialysis, or if they've talked to you about "low flows" or "high pressures" after any recent flow tests performed in the dialysis center. These can all be signs that something is going on that can be improved for you.

The procedure itself usually takes less than 10 minutes. You will be asked to lie down in the procedure room. If that is difficult for you, we can use pillows to elevate your head and make sure you are comfortable. If you usually have oxygen when lying down, we can provide that for you during the procedure as well. To learn more about the procedure.

Before you leave we will discuss a good time for your next appointment and get that scheduled for you.

What is special or different about what you do at CSA?

At CSA providing high quality patient care is at the forefront of everything that we do. We are taking care of our friends and family in a small community, so we understand the importance of putting our patients first.

To Make an Appointment

Your initial consultation at Columbia Surgical Associates gives you the opportunity to meet our dialysis team, learn more about our services and find out which treatment options will best meet your needs.
To schedule a prompt appointment with one of our board-certified vascular surgeons, please call our dedicated Dialysis Access Coordinator at Columbia Surgical Associates: 573-777-3303

Dr. Salinas
Dr. Humphrey
Dr. Adams
Dr. Sanford