AV Fistula surgery is carried out to allow dialysis for patients with kidney failure. Once your kidney specialist decides that you are likely to or will need dialysis a method will need to be found.
Sometimes a permacath for dialysis is placed- this is a plastic tube in your blood vessel that is placed under ultrasound and or Xray. Many patients who have complicated problems are referred to the vascular and endovascular surgeons of the Vascular Centre because of their expertise in dealing with such challenges.
Fistula surgery is the other and best option for dialysis. All over the developed world, the AV fistula is the preferred method for doing dialysis. The cost of dialysis in Bangalore varies depending upon the complexity of the surgery and whether additional material is required.
Dialysis Access
People with end stage kidney failure need a way to undergo dialysis till they can have a successful kidney transplant.
The first step is establishing dialysis access one of four ways:
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A catheter in your neck / groin—temporary, because the possibility of infection is high.
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A tunnelled catheter in chest / thigh – can be kept for longer periods, more resistant to infection.
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An AV fistula—taking a piece of a vein from your arm or leg and sewing it into a nearby artery, making the vein large and thick so that it can be punctured during dialysis. The best option because it has the lowest risk of infection. A fistula takes upto 6 weeks – 8weeks from the time of surgery to be ready for use for dialysis.A good working fistula can last upto 6 to 8 years.
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An AV graft—the sewing of an artificial tube between an artery and vein in your arm or leg. The preferred option if your veins are too small for an AV fistula. AV grafts are more prone to infection because they are not formed from natural tissue. A V graft s can be used for dialysis with 1 – 2 weeks with some grafts that can be used as early as 48 hrs after surgery.
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Peritoneal dialysis—placement of a small tube, called a cannula, in your abdomen to allow the use of the lining of the abdomen (peritoneum) to filter your blood. It requires several “exchanges” every day: you introduce and remove fluid through the tube. A convenient option because you perform the dialysis therapy at home, but infections sometimes occur and the tube can become clogged.
Timing of dialysis access
Your nephrologist may plan your dialysis access months in advance, which enables you to have a working fistula in place which the best type of access instead of starting dialysis with catheters. Vascular surgeons can help you plan the type of fistula / graft by studying the vessels in your limbs.
Failure of access
Dialysis access are known to fail in 5 to 10 percent of cases. Catheters may get blocked or infected and require a change of access.
Fistula / Grafts can develop decreased flow , get partially or totally blocked.
Long standing dialysis catheters can cause central vein stenosis or blockage. A variety of procedures can be done for salvaging fistulas and grafts depending on length and duration of blockage and condition of vessels.
Fistula Salvage procedures
Fistuloplasty
Similar to an angiogram, this technique involves putting a small tube in your fistula and dilating the narrow segment of your fistula with the balloon and improving the flows. This is a daycare procedure done under x ray guidance and fistula can be used the next day.
Central Vein angioplasty
Narrowing or blockage in the cental veins ( SVC , Innominate, subclavian ) can be tackled effectively by balloon angioplasty and stenting if required.
Graft Thrombectomy
This is an open surgical technique in which clot in the graft is removed with a special catheter froma asmall incision in your limb. The procedure can be done under local anaesthesia if you are fit and the graft can be used for dialysis the following day.
Tips to maintain your dialysis access
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Good local hygiene
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Avoid pressure or blood sampling in the limb
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Soft Ball exercise
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Regular follow up with your vascular surgeon at least once in three months if you have undergone a salvage procedure
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Control blood pressure, Low blood pressure can cause blockage of your fistula
Often the dialysis centre in Bangalore will be different from the centre where the permacath for dialysis is placed or where the fistula surgery is performed.
