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AV Fistula Creation

An arteriovenous (AV) fistula is a surgically created connection between an artery and a vein, typically in the arm, to provide access for hemodialysis in patients with end-stage renal disease. Vascular surgeons are typically responsible for performing this procedure. Here's a general overview of how vascular surgeons create an AV fistula: 1. Patient Evaluation: The patient undergoes a thorough evaluation to assess the suitability of creating an AV fistula. This evaluation includes assessing the quality and size of the patient's blood vessels, typically the radial artery and cephalic vein in the forearm. 2. Anesthesia: The patient is given local anesthesia to numb the area where the fistula will be created. In some cases, depending on the patient's condition and preference, regional or general anesthesia may be used. 3. Identifying Suitable Vessels: The surgeon identifies suitable vessels for creating the fistula. The radial artery and cephalic vein are commonly used due to their accessibility and size. Doppler ultrasound may be used to assess blood flow and vessel characteristics. 4. Surgical Incision: The surgeon makes an incision over the selected area, typically in the forearm, to access the artery and vein. 5. Connecting Artery and Vein: The surgeon then carefully connects the artery to the vein, creating a direct communication between the two vessels. This can be done by making a small incision in both vessels and suturing them together, or by using specialized devices such as vascular grafts or fistula needles. 6. Ensuring Blood Flow: After the connection is made, the surgeon ensures that blood flow through the fistula is adequate. This may involve assessing the pulse in the artery downstream from the fistula and checking for a thrill (vibrations) and bruit (swishing sound) over the fistula site. 7. Closure: Once the fistula is created and blood flow is confirmed, the incision site is closed with sutures or surgical staples. 8. Postoperative Care: The patient is monitored closely after the procedure to ensure proper healing and function of the fistula. Instructions are given on how to care for the fistula site to prevent infection and promote healing. 9. Follow-Up: Patients typically have regular follow-up appointments with their vascular surgeon to monitor the function of the AV fistula and address any issues that may arise. Creating an AV fistula requires precision and expertise to ensure optimal function and longevity of the access site for hemodialysis.