Arteriovenous Fistula in Nice
Dr. Ilya Khantalin, Vascular Surgeon in the Alpes-Maritimes
Arteriovenous Fistula
Dr. Ilya Khantalin in Nice
An arteriovenous fistula (AVF) is a surgical procedure performed to create vascular access for patients requiring long-term dialysis. Designed to connect an artery and a vein, the AVF plays a central role in the management of chronic kidney disease by offering a reliable access point for dialysis treatments.
Endovascular techniques now represent the most modern and commonly used approaches by vascular surgeons, in accordance with the recommendations of the Haute Autorité de Santé and integrated into standardized surgical protocols.
Vascular diseases are recognized as Long-Term Illnesses (Affections de Longue Durée – ALD), which allows for 100% coverage by French Social Security.
What Is an Arteriovenous Fistula?
Vascular Surgeon in Saint-Laurent-du-Var
An arteriovenous fistula is a direct connection between an artery and a vein, typically created in the upper limbs. This connection increases blood flow in the vein, leading to high flow and causing the vein walls to thicken and strengthen. Once “matured,” this altered vein can tolerate frequent punctures required for hemodialysis.
The AVF is most often created in the arm, between the radial artery and cephalic vein or between the brachial artery and basilic vein. The choice depends on the patient’s anatomy and the condition of the venous network.
Indications and Advantages of an Arteriovenous Fistula
Vascular Surgery Specialist in Saint-Laurent-du-Var
Indications for Creating an AVF
The primary indication for creating an AVF is advanced chronic kidney disease, when the patient is in the terminal phase of renal failure and dialysis becomes necessary. Before proceeding with the procedure, various tests are conducted to assess the size and quality of the blood vessels.
The decision to create an AVF also takes longevity into account. Compared to other types of vascular access, such as catheters, AVFs result in fewer infections and offer greater long-term durability. It is therefore the preferred option when the patient’s clinical condition allows.
Steps in Creating an Arteriovenous Fistula
Creating an AVF is a relatively short surgical procedure but one that requires high precision. The general steps are:
- Preoperative Assessment: The surgeon first performs a clinical evaluation of the patient and an ultrasound Doppler examination of the upper limbs to identify the best site for creating the fistula.
- Anesthesia: Local or regional anesthesia is generally sufficient, although general anesthesia may be used if necessary.
- Creation of the Fistula: The surgeon makes an incision to access the selected vessels and creates the connection between the artery and the vein.
- Closure and Monitoring: After verifying blood flow through the new fistula, the incision is closed and the patient is monitored to ensure there are no immediate complications.
Postoperative Follow-Up for an Arteriovenous Fistula
Follow-up after AVF creation is essential to ensure proper function and durability. In the weeks following the procedure, the fistula must “mature”—develop and strengthen to allow repeated dialysis punctures.
- Maturation: Fistula maturation typically takes 6 to 12 weeks. During this period, patients are encouraged to perform exercises, such as squeezing a soft ball, to improve blood flow.
- Regular Monitoring: Clinical evaluation and Doppler ultrasound help ensure the fistula is functioning properly. It is important to monitor for signs of complications such as pain, redness, or reduced blood flow.
Patient Education: Patients must learn to recognize warning signs, such as the absence of a “thrill” (vibration indicating blood flow), abnormal swelling, or persistent pain. Good hygiene and proper care of the access site are also essential.
Potential Complications of an Arteriovenous Fistula
Although AVFs are generally reliable, complications can occur. The most common include:
- Thrombosis: Clot formation blocking the fistula is a frequent complication that may require urgent intervention to preserve vascular access.
- Infections: While AVFs are less prone to infection than catheters, vigilance for signs of infection remains necessary.
- Stenosis: Narrowing of the vessel can reduce blood flow and compromise fistula performance.
- Aneurysm: Over time, some fistulas may dilate and form aneurysms, which must be monitored and treated if needed.
Alternatives to an Arteriovenous Fistula
If an AVF cannot be created—due to small veins or vascular complications—other dialysis access options may be considered:
- Dialysis Catheter: A temporary access point placed in a central vein, but more prone to infection.
- Vascular Graft (AV Bridge Graft): A synthetic tube connecting an artery to a vein, allowing durable access to dialysis, though with higher complication rates than AVFs.
Benefits of an Arteriovenous Fistula
The AVF is often favored due to its many advantages over other vascular access methods. It offers a lower rate of infectious complications, better long-term patency, and greater durability. These benefits make it the first-line option for patients requiring prolonged dialysis, contributing to a higher quality of life.
The arteriovenous fistula is a vital and lasting solution for patients with advanced chronic kidney disease who require dialysis. Though technically demanding, it provides reliable and safe access. Proper monitoring, vigilance for complications, and patient education are key to maintaining its function.
As a vascular surgeon, Dr. Ilya Khantalin provides comprehensive management and follow-up of upper limb AVFs to optimize all available therapeutic options.