AV Fistula – The Details

There’s good news and there’s bad news I would say.

Bad news – My kidneys are failing

Most people would be shocked an a little anxious for me. They would ask me questions on the different things in my blood like creatinine, urea and eGFR and things like that. But they would soon recover, and the recovery was partly because I had said there was good news too – which was just really a placebo.

Upon insistence, I would say the good news is that

I find myself in an unenviable position

Those who knew and loved me enough would crack up and the rest would pout a sad face.

My doctor who has been seeing me for more than 16 years now said that it would be safe to get an AV Fistula done as there was no telling when I might need dialysis and the AV Fistula needs anywhere between 8-12 weeks to mature and be usable for dialysis. Meaning you need to get the AV Fistula done well in advance of your first dialysis sitting.


What is Dialysis?

Dialysis is the process of purifying blood. Our kidneys perform this function and remove toxins and other waste products from the body. When the kidneys have nearly completely failed, the body has no way of regulating the chemical composition and water balance of the body. This will eventually lead to malfunction and failing of other organs like the heart, liver and brain any of which can lead to sudden or slow descend to death.

To prevent this, the medical sciences have invented a method to carry out this process of blood purification outside the human body using a machine unimaginatively called the dialysis machine. The patient is hooked up the machine, two needles are connected into a single vein which acts as both artery and a vein. The needles again, quite obviously are called the arterial needle and the venal needle. Blood is pumped out – using the patient’s own internal blood pressure and no external pump – from the body and made to flow through a long series of pipes lined with osmotic membranes, which is nothing but layers of skin or organic film will allow separation of toxins, chemicals and other waste from the blood. The process is repeated for about 3-4 hours until all of the blood in the body is purified. Depending on the damage of the kidneys and the requirement of the patient, dialysis can be prescribed anywhere between 4 times a month to 3 times a week.

All details listed above are for hemodialysis, there is also a method called peritoneal dialysis – which doesnt require a fistula or getting hooked on a huge machine for 4 hours. Look it up.


What is an AV Fistula?

An AV Fistula is basically an abnormal condition where an artery and a vein interlock and become one. That is, blood from the artery flows into the vain thereby making it swell up.

This abnormality is artificially created in case of patients who need dialysis by surgically connecting an artery to a suitable vein. The process is generally done under local anaesthesia at a few known access points like the wrist or elbows or thighs – choice of the access point for creation of the Fistula is made based on the built of the patient and availability of suitable veins.

Why AV Fistula?

There are 2 reasons,

As we’ve learnt a little while ago, needles – substantially thick needles – are inserted into the patient’s body. Now the arteries are thick and fat and can take the piercings, but veins are not always thick and repeated piercings can collapse the veins, secondly, blood flows in the veins in relatively low pressure and hence pumping gallons of blood back into the body for 4 hours may not be possible without proper pressure. The Fistula creates a pressure that is generally higher than usual venal pressure and makes the veins capable of handling blood flow possible.

Other options

Apart from an AV Fistula, doctors may also suggest creation of AV grafts, where in an inorganic connection – in form a tube – is created between the artery and the vein thus performing the same function.

Both the AV Fistula and AV graft need some time. Around 2-3 months to mature and get the veins ready for the reoccurring process of dialysis.

There is 3rd option using an intravenous catheter. This catheter doesn’t need a maturity time and is generally used in case of emergencies.

When it comes to other factors like longevity, usability and maintenance , the AV Fistula is called the best option as it is completely organic, is least prone to clotting and infections. Whatever you choose, you can live a long life on dialysis if you are ready to make some lifestyle changes and stay vigilant of your condition.

Ofcourse if you have a long life to live and have the means to afford it, you should read up on kidney transplant and give it a shot.

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