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Cost of Arteriovenous Fistula Treatment

  • Posted on- Apr 03, 2018
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An AV fistula or Arteriovenous Fistula is a permanent form of vascular access procedure (dialysis access procedure) that creates a vein in the arm that is

  1. High Caliber or has a wide lumen through which blood can flow easily
  2. No valves - These veins have no valves preventing obstruction in the flow
  3. Easily visible or felt - for easy cannulation for dialysis
  4. Heals easily after a puncture
  5. Thick muscular walls to prevent rupture during high flow dialysis.

This is achieved by a phenomenon known as arterialization of a vein. The surgeon artificially takes a small vein in the arm or wrist and joins it to an artery in the hand in AV Fistula Surgery. The arterial system has very high flow blood because it directly comes from the heart.

Advantages of AV Fistula

AV Fistula is a preferred choice for permanent hemodialysis. This is because of the following reasons

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  1. It is a permanent solution - no need for repeated procedures
  2. No need to carry any pipe or tubing with you all the time
  3. 500 times less risk of infection than catheters
  4. No risk of central venous stenosis
  5. Freedom to stay near a dialysis centre, as fistula can be cannulated anywhere
  6. Cheaper on the long run

Disadvantages of AV Fistula

The reason why people hate an AV Fistula before they have one is the fear of surgery. This is the reason they keep delaying it until they go through the pain of inadequate central venous access and then find that they cannot have an AV fistula and then they run from pillar to post to find a salvage procedure.

There is no real disadvantage and all major professional medical organizations now recommend that 80% of patients bound to reach hemodialysis get mature fistulas before they start dialysis.

Distal Wrist AV Fistula

The most common and beneficial fistula is the distal wrist AV fistula. Every dialysis patient should consider the arm veins as a vital real estate. If it is possible the most distal arteries and veins should be used.

Distal would mean as near the wrist as possible because all fistulas ultimately have a life. At some point, your doctor may need to revise and make a fistula proximally or in other words move up the arm towards the elbow or higher.

This fistula can be created in either arm, and usually the surgeons will prefer the nondominant arm, but there is no compulsion. It will always depend on the quality of the arm, and the quality of veins available.

Sometimes in 10% of patients, a distal AV fistula is not possible, and then the surgeon may primarily move onto a forearm fistula.

A transposition AV fistula is possible if a radio cephalic fistula is not possible, if the patient is willing, and the surgeon is proficient. A dominant forearm vein can be removed and patched to the wrist and it works well.

But as far as possible, it is essential that all possible efforts are made to construct a distal fistula.

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Proximal Arm AV Fistula

In cases where the wrist veins are unsuitable and no transposition grafts can be done, the surgeon has an option to make a proximal fistula. In this surgery, the vein chosen is in the forearm near the elbow and the fistula works in the arm.

An example could be a Radio Brachia artery fistula, an antecubital vein and a brachial artery fistula, a basilic vein transposition or others.

The timing of AV Fistula Surgery

Most patients suffering from kidney disease become aware of the fact that they will require some form of dialysis in the future and they begin preparation well in time in terms of finding family support and creating financial resources.

But, one discussion Indian patients universally avoid is for the creation of an AV fistula. Reasons for this are many. Among them chief are

  1. The feeling that they may never need dialysis - a state of denial
  2. The feeling that they may get more time and they will get it done later
  3. The feeling of fear of surgery which they feel is unnecessary
  4. The feeling of ignorance - where they know they need it, but are too ignorant
  5. Socio-Cultural and Economic factors - Family members, support groups or financial conditions may not permit

There are specific precautions that they should follow by default even if they are not planning to get a fistula constructed.

  1. Get immunized for Hepatitis B, Influenza and Pneumonia
  2. Prevent the use of any arm (especially the preselected arm) from any form of injury or needle puncture
  3. No drug catheters or blood samples from the preselected arm.

Reasons for failure of AV Fistula

The reasons for Dialysis Access failure are many and are discussed below

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  1. Inflow Stenosis - The fistula never matures and there is inadequate flow in the fistula
  2. Outflow Stenosis - There is central vein narrowing due to past cannulation and repeated needle puncture
  3. Diabetes and Hypertension
  4. Inappropriate cannulation
  5. Prolonged Dialysis
  6. Old Age
  7. Inappropriate Surgery or technique
  8. Venous Thrombosis
  9. An aneurysm due to the wrong technique of punctures

Complications of AV Fistula

AV fistulas and Dialysis Access are life-saving and work well, but they are prone to complications. These complications are many, but the two most important are

  1. Thrombosis - After a long dialysis session, a clot may get stuck in the vein jamming it. It is an emergency and may not only ruin the fistula but may cause the arm to go bad.
  2. Aneurysm - Repeated wrong punctures may weaken the wall of the fistula and cause the arm to swell. It is again an emergency and requires emergent surgery.

Care of AV Fistula

Once the fistula is ready and matured, certain precautions can extend the life of your AV fistula and Dialysis access. These are

  1. Keep your hand clean and moisturized to prevent any infections
  2. Get the fistula punctured by only trained technicians either by "Bulls Eye technique" or " 3 point technique"
  3. Post hemodialysis ensure that there is thrill and bruit
  4. Regular checkup of the fistula
  5. If the fistula stops pulsating, rush to the emergency within 6 hours
  6. Do not puncture the arm with the fistula ever
  7. Keep moving and exercising the arm to keep the blood flowing

This fistula care can keep your fistula healthy for a long time.

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