Failing Arterio Venous Fistula
What is an AV Fistula?
Arteriovenous fistulas (AVF) are surgically created in chronic kidney disease patients who have a high chance of going onto maintenance hemodialysis.
Why is it important?
AVFs are the lifeline for the patients who are dependant on dialysis. They are the most sustained and reliable accesses for dialysis. The options of AvF indirectly correlate with longevity of the patient if renal transplant is not an option.
Why do AVF fail?
The matured vein is subjected to repeated trauma due to high flow and needling which results in the lumen getting narrowed progressively and eventually get occluded.
Signs or Symptoms of Failure?
1. Decreased or absent thrill or bruit over the fistula
2. Decreased flows during dialysis
3. Increased venous pressures
4. Increased or prolonged bleeding post dialysis
How do we prevent failure?
Frequent surveillance (3-6months) with Ultrasound/Doppler is recommended for AVF without any of the above signs. If there are signs of failure, it’s high time to see your Vascular Surgeon or Vascular Interventional Radiologist.
How is it treated?
If there are significant narrowing on Ultrasound screening, a fistulogram is done which is nothing but angiogram of fistula in which dye is injected through a small tube inserted in the fistula vein and balloon angioplasty (Fistuloplasty) of the narrowed or occluded segments is performed in a cathlab.
