Renal Access Surgery and Fistulas

Patients who have kidney failure need dialysis to filter their blood. Two common forms of dialysis are peritoneal and haemodialysis. Peritoneal dialysis is when a small tube is placed into the abdomen and fluid is filled and drained several times a day. Haemodialysis is when blood is drawn and passed through an external machine to clean and returned back into the patient. Haemodialysis takes 3 to 4 hours usually three times a week.

Vascular surgeons perform operation to enable haemodialysis to occur. A fistula is created usually in the arm to enable blood to be drawn and returned. The best option is using your own existing vein in the arm and attaching it to the artery in your arm. This is called an arterial-venous fistula. Two needles are then placed into the vein each time dialysis is required.

The decision on what fistula and where to create can be complex. If formed at the wrist is referred to as radiocephalic fistula. If formed at the elbow is it referred to as brchiocephalic fistula. These two are the most common, however many other options including fistulas in the legs can be created. Vascular surgeons are trained in advising you can creating the best option for you.

Before the operation an ultrasound or venogram may need to be performed to select the best option. The operation takes one hour and patient go home the following day. It takes 6 to 8 weeks before the fistula can be used.