ARTERIOVENOUS FISTULA

• TO CREATE A FISTULA, A VASCULAR SURGEON JOINS AN

ARTERY AND A VEIN TOGETHER THROUGH ANASTOMOSIS

• BLOOD FLOWS RAPIDLY THROUGH THE FISTULA

• FEELING FOR "THRILL" OR LISTEN FOR SOUND CALLED BRUIT

• FISTULAS ARE USUALLY CREATED IN THE NONDOMINANT ARM

• SITUATED:

- THE FOREARM (USUALLY A RADIOCEPHALIC FISTULA,

OR SO-CALLED BRESCIA-CIMINO FISTULA)

- OR THE ELBOW (USUALLY A BRACHIOCEPHALIC

FISTULA)

• A FISTULA WILL TAKE A NUMBER OF WEEKS TO MATURE ON

AVERAGE PERHAPS 4-6 WEEKS
 ADVANTAGES OF THE AV FISTULA

• LOWER INFECTION RATES SINCE NO FOREIGN MATERIAL IS

INVOLVED IN THEIR FORMATION

• HIGHER BLOOD FLOW RATES (WHICH TRANSLATES TO MORE

EFFECTIVE DIALYSIS)

• LOWER INCIDENCE OF THROMBOSIS

 COMPLICATIONS OF AV FISTULA

• STEAL SYNDROME - BLOOD ENTERING THE LIMB IS DRAWN INTO

THE FISTULA AND RETURNED TO THE GENERAL
CIRCULATION WITHOUT ENTERING THE LIMB'S
CAPILLARIES

- RESULTS IN COLD EXTREMITIES OF THAT LIMB,

CRAMPING PAINS, AND, IF SEVERE, TISSUE
DAMAGE
• ANEURYSM - BULGING IN THE WALL OF THE VEIN WHERE IT IS

WEAKENED BY THE REPEATED INSERTION OF NEEDLES

OVER TIME

- NEEDLE TO BE INSERTED AT DIFFERENT POINTS IN A

ROTATING FASHION OR USE BUTTONHOLETECHNIQUE

 AV GRAFT

• AV (ARTERIOVENOUS) GRAFTS ARE MUCH LIKE FISTULAS IN

MOST RESPECTS, EXCEPT THAT AN ARTIFICIAL GRAFT IS USED
TO JOIN THE ARTERY AND VEIN

• THE GRAFT USUALLY IS MADE OF A SYNTHETIC MATERIAL,BUT

SOMETIMES CHEMICALLY TREATED, STERILIZED VEINS FROM
ANIMALS ARE USED
• GRAFTS ARE INSERTED WHEN THE PATIENT'S NATIVE

VASCULATURE DOES NOT PERMIT A FISTULA

• THEY MATURE FASTER THAN FISTULAS

 COMPLICATIONS

• RISK OF NARROWING, ESPECIALLY AT VEIN SITE

• CLOTTING OR THROMBOSIS

• HIGH RATES OF INFECTION

• MORE OPTIONS FOR SITES TO PLACE A GRAFT ARE

AVAILABLE, BECAUSE THE GRAFT CAN BE MADE QUITE LONG

• THUS A GRAFT CAN BE PLACED IN THE THIGH OR EVEN THE

NECK (THE 'NECKLACE GRAFT')