AV Fistula Surgery in Pune: Creating Access for Dialysis

What is an AV fistula?

People with kidney failure who need haemodialysis must have their blood pumped through a dialysis machine several times a week. This needs a reliable way to reach a high-flow blood vessel, called vascular access.

An arteriovenous (AV) fistula is made by joining an artery directly to a nearby vein, usually in the forearm or at the elbow. Arterial blood flowing into the vein makes it grow larger and its wall thicker over several weeks, so it can be needled repeatedly for dialysis.

The main types are:

• Radiocephalic fistula at the wrist, the usual first choice.
• Brachiocephalic fistula at the elbow.
• Brachiobasilic fistula, where a deeper vein is moved closer to the skin, sometimes in two stages.

When suitable veins are not available, an AV graft (a soft tube joining artery and vein) may be used.

Who needs an AV fistula, and how is it planned?

A fistula is planned for people with advanced chronic kidney disease who are expected to start haemodialysis, usually on the advice of their nephrologist. Planning includes:

1. Protecting arm veins: avoiding blood tests and drips in the planned arm where possible.
2. Ultrasound vein mapping to check the size and depth of veins and the arteries.
3. Choosing the site: as far down the non-dominant arm as suitable vessels allow.
4. Timing: early enough to allow maturation before dialysis is needed.

What are the access options?

Option	Points in favour	Points to consider
Wrist fistula	Saves higher sites for the future	May take longer to mature; small vessels
Elbow fistula	Higher flow; matures well	Slightly higher risk of steal syndrome
Transposed basilic fistula	Uses a deep vein	Longer cut; sometimes two operations
AV graft	Usable sooner	Higher risk of clots and infection than a fistula
Dialysis catheter	Immediate use	Highest infection risk; usually temporary

Fistula creation uses the same vessel-joining techniques described under blood vessel repair surgery.

How is AV fistula surgery performed?

1. Anaesthesia: local anaesthetic or a regional arm block.
2. Incision: a short cut at the wrist or elbow.
3. Joining: the vein is connected to the side of the artery with fine stitches, often under magnification.
4. Checking: the surgeon confirms a buzz (thrill) over the vein.
5. Closure and dressing: you usually go home the same day.

How should you prepare, and what should you ask?

• Avoid blood tests, drips and blood pressure cuffs on the chosen arm.
• Tell the team about blood thinners and diabetes.
• Follow advice about dialysis timing and medicines before surgery.

Questions to ask:

• Which site do you recommend, and why?
• How will we know the fistula is maturing?
• What exercises should I do?
• What is the plan if it does not mature?

What is recovery like?

Time	What to expect for most patients
Days 1-3	Mild pain and swelling; keep the arm raised; feel for the buzz daily
Weeks 1-2	Stitches removed; gentle hand exercises as advised
Weeks 4-6	Fistula checked by examination or ultrasound
Weeks 6-8 or more	First needling for dialysis when the fistula is ready

What are the risks?

• Failure to mature: reported in a substantial proportion of fistulas, sometimes needing a further procedure.
• Clotting (thrombosis): the buzz stops; urgent treatment may save the fistula.
• Bleeding or haematoma.
• Infection, less common than with grafts or catheters.
• Steal syndrome: reduced blood to the hand, causing coldness, pain or numbness.
• Swelling of the arm or aneurysm (enlarged segment) over time.

Contact the team urgently if the buzz stops, the hand becomes cold, painful or numb, or the fistula bleeds or swells.

What results can you expect?

Most fistulas mature well enough for dialysis, sometimes after a small additional procedure. A working fistula can last for years with care, and it usually has fewer infections and clots than other access types.

What happens if a fistula is not made in time?

Advanced chronic kidney disease usually worsens over months to years, and the timing of dialysis is guided by your nephrologist. Because a fistula needs about six to eight weeks or longer to mature, leaving surgery until dialysis is urgent usually means starting treatment through a catheter in a neck vein, which carries a higher risk of infection and clots. Arm veins used repeatedly for blood tests and drips can scar and become unsuitable, narrowing the choice of sites. If a fistula is made but not checked, early problems such as poor flow may be missed until it is needed. Haemodialysis is not the only path: peritoneal dialysis, a kidney transplant or conservative kidney care may suit some people, and your kidney team will discuss these.

Common myths about AV fistulas

• “Making a fistula means I must start dialysis straight away.” A fistula is often made weeks to months before dialysis is needed, so that it has time to mature.
• “A neck catheter is just as good as a fistula.” Catheters help when dialysis is needed urgently, but they carry a higher risk of infection and clots than a fistula.
• “The buzz in my arm means something has gone wrong.” The buzz (thrill) shows that blood is flowing through the fistula, and it is losing the buzz that needs urgent attention.
• “Once the fistula is made, that arm can be used for blood tests and injections.” Blood tests, injections and blood pressure cuffs should be avoided on the fistula arm to protect it.

What affects the cost of AV fistula surgery in Pune?

• Type of fistula: wrist, elbow or transposed vein.
• Vein mapping and follow-up ultrasound.
• Anaesthesia and facility charges.
• Additional procedures if the fistula needs help to mature.

Dialysis access surgery is medical treatment and is often covered by health insurance, subject to your policy.