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Arteriovenous fistula, causes and treatment

Arteriovenous fistula, causes and treatment

Top Doctors
Top Doctors editorial
Top Doctors
Created by: Top Doctors editorial Sources: Top Doctors CO
Edited by: TOP DOCTORS® at 16/08/2022

The arteriovenous fistula is the union of an artery and a vein from the patient . These fistulas may– patologicas- conditions in spontaneously arise in some circulatory diseases or result from various traumas, but this type of fistulas did not refer in this article, because these are pathological nature.

Arteriovenous fistulas Vascular Surgeons who perform for patients with chronic renal failure, are fistulas“therapeutic”. They are exactly the union between an artery ( deep situation ) with a vein of the superficial venous system, usually in wrists, forearms or arms. Thus, a vein surgically connected to the artery occurs gradually increases its size in the course of several weeks, until it is of sufficient size ( approximately 6 mm. diameter) to permit periodic dialysis.

 

Fistulas upper limb

The vast majority of dialysis fistulas practiced in the upper limbs , as they are much more accessible than the veins of the lower extremities and usually have lower rate of any complication. Also patients with severe renal impairment may develop over time, also, peripheral arterial pathology ( in the lower limbs ) and this discourages the creation of these fistulas in these extremities, as could exacerbate ischemia.

 

Alternatives to the creation of an arteriovenous fistula

The main alternative is the placement of a permanent dialysis catheter through a central vein, usually the internal jugular vein at the base of the neck or the subclavian vein. However, the main drawback of the implant of central catheters is the potential risk of infection, given that they are in a“internal” to the vicinity of the right atrium. So long as you can have a vascular access arteriovenous fistula type, it is preferable to catheter dialysis, although there are numerous exceptions to this rule like so many aspects of medicine, require extensive evaluation by the nephrologist and vascular surgeon.

In other cases the fistula can not be performed with the patient's own veins when these poor quality, and the main surgical alternative in this case is a bypass with prosthesis, so joining the venous system directly to the artery.

 

Treatment of arteriovenous fistula to prevent obstruction

Indeed, the specialist in Angiology and Vascular Surgery with specialist Nephrology evaluate each case to provide the most appropriate patient whose vascular access is not working properly. Sometimes the fistula primary form correctly or not mature over time creates areas of stenosis (“narrowings” veins after repeated punctures ). If detected, with techniques endovascular surgery can be solved in many cases these problems by prolonged dilatation of these areas of stenosis with angioplasty balloons, like in the picture.

 

Fistulogram where stenosis is seen by hyperplasia in arteriovenous fistula for dialysis successfully treated with percutaneous angioplasty.

 

Vascular surgery