AV Fistula Creation
A reliable access is the lifeline of every dialysis patient. In this operation, an artery in your arm is joined to a vein so the vein grows strong enough for regular dialysis needles. We plan it with vein mapping and create it with fine vascular surgery.
Book an Appointment Explore ProceduresHow an AV fistula works
An arteriovenous (AV) fistula is a surgical link between an artery and a vein, usually in the arm. It is the preferred long-term access for haemodialysis when your vessels allow it.
Who needs an AV fistula?
Your kidney doctor (nephrologist) and vascular surgeon decide together. Early referral gives the fistula time to mature before dialysis starts.
- Advanced chronic kidney disease, when dialysis is expected
- Patients already on dialysis through a catheter
- Patients whose earlier access has failed or become blocked
- Patients who need long-term, repeated dialysis access
Our AV access procedures
Choose a procedure to see where the connection is made on the arm. Red is artery blood and blue is vein blood. The glowing cyan point is where the artery and vein meet.
Vein mapping
Every access plan starts here. A Doppler ultrasound studies the arteries and veins of both arms so the best vessels and the best site are chosen before any cut is made.
What happens
- Vein and artery widths are measured, often with a tourniquet
- Depth, blood flow and any blockages are checked
- The surgeon marks the skin to guide the operation
Why it matters
- Raises the chance that the fistula will mature
- Helps decide between wrist, elbow, upper arm or graft
- Shows if the arm should be preserved from needles
Radiocephalic fistula (wrist)
The radial artery is joined to the nearby cephalic vein at the wrist. When the vessels are suitable, this is usually the first choice, because it keeps the upper arm free for later access.
What happens
- A small cut is made at the wrist
- The vein is freed and its end joined to the side of the artery with fine stitches
- The surgeon feels the buzz (thrill) to confirm flow
Advantages and limits
- Preserves the upper arm veins
- Lower risk of the hand becoming cold or painful
- Smaller vessels can mean a slower or failed maturation
Brachiocephalic fistula (elbow)
The brachial artery is joined to the cephalic vein at the elbow. It is chosen when wrist vessels are small or have failed. The larger flow often helps the vein grow well.
What happens
- A cut is made over the elbow crease
- The cephalic vein is joined to the brachial artery
- Flow is checked before the wound is closed
Advantages and limits
- Good flow and usually a high chance of maturing
- A long vein length for dialysis needles
- Higher chance of a cold hand (steal) and arm swelling than at the wrist
Brachiobasilic fistula (upper arm)
When other veins are unsuitable, the deeper basilic vein is joined to the brachial artery. Because this vein runs deep, it is moved (transposed) closer to the skin so needles can reach it.
What happens
- The basilic vein is freed along the inner upper arm
- It is joined to the brachial artery
- The vein is placed in a new, shallower path under the skin
- This may be done in one or two stages
Advantages and limits
- Makes use of a large vein that is rarely punctured
- A bigger operation, with more swelling and a longer healing time
- Needs careful follow-up for steal and swelling
AV graft (synthetic tube)
If your own veins are too small, a soft synthetic tube joins an artery to a vein under the skin. Dialysis needles are placed into the tube itself.
What happens
- A tunnel is made under the skin of the forearm or upper arm
- The graft is sewn to an artery at one end and a vein at the other
- Flow is checked before closing the cuts
Advantages and limits
- Can often be used earlier than a fistula, in a few weeks
- Works when veins are too small for a fistula
- Higher risk of clotting and infection, and may need repeat procedures
Fistuloplasty (balloon rescue)
Fistulas can narrow over time or fail to mature. A balloon procedure opens the narrowed vein without a major operation and can bring a struggling fistula back to working order.
When it is needed
- A fistula that is not maturing
- Poor flow or long bleeding after dialysis needles
- Arm swelling or a change in the thrill
What happens
- Contrast dye and X-ray show the narrowing
- A wire is passed across it and a balloon is inflated
- A stent may be added in selected cases
- The narrowing can return, so repeat treatment may be needed
Your operation, step by step
Before surgery
- Vein mapping and blood tests
- Tell us about all medicines, especially blood thinners and diabetes medicines
- Protect the arm chosen for access: avoid blood draws and drips in it
- Follow your fasting instructions if given
- Plan someone to accompany you home
On the day
- Check-in and reviewYour arm marks, scan and consent are checked.
- AnaesthesiaLocal, regional or general, matched to the operation and to you.
- Cleaning and preparationThe arm is cleaned and covered with sterile drapes.
- Exposing the vesselsA small cut is made and the artery and vein are carefully freed.
- Joining artery and veinThe connection is sewn with very fine stitches.
- Checking the flowThe thrill is felt and the hand is checked for good blood supply.
- Closing and recoveryThe wound is closed, and you are watched until you are fit to go home.
How your fistula matures
A fistula needs time before it can be used. The bars show the vein widening. Your timeline may differ.
Fistula, graft or catheter?
Your doctor chooses based on your veins, your health and how soon you need dialysis.
| AV fistula | AV graft | Tunnelled catheter | |
|---|---|---|---|
| Made from | Your own vein | Synthetic tube | Soft tube in a neck vein |
| Ready to use | Weeks to months | Often 2 to 4 weeks | Immediately |
| Durability | Usually the longest lasting | Shorter than a fistula | Short-term bridge |
| Infection risk | Lowest | Moderate | Highest |
| Clotting and narrowing | Lower | Higher, more repeat procedures | Possible blockage of the tube |
| Best for | Patients with suitable veins and time to wait | Small or damaged veins, or earlier use needed | Urgent dialysis before access is ready |
Risks and aftercare
AV access surgery is common and generally safe, but every operation has risks. Your surgeon will discuss them with you.
Possible risks
- Bleeding or a collection of blood (haematoma)
- Wound infection
- Fistula that does not mature
- Narrowing or clotting of the fistula
- Steal syndrome, where the hand gets too little blood
- Swelling of the arm or an enlarged (aneurysmal) segment
- Rarely, extra strain on the heart from very high flow
Call us the same day if you notice
- The buzz (thrill) is weak or has stopped
- Redness, pus, warmth or fever
- A cold, pale, numb or painful hand
- Bleeding from the wound or a fast-growing lump
- New or sudden swelling of the arm
Do
- Feel for the buzz every day
- Keep the arm clean and the wound dry
- Do hand exercises as your team advises
- Keep all follow-up and scan visits
Do not
- Allow blood pressure checks or blood draws on that arm
- Wear tight sleeves, watches or bands on it
- Lift heavy loads or sleep on that arm
- Ignore a cold, pale or painful hand
Frequently asked questions
Which arm will be used?
Often the arm you use less, but vein mapping decides. The arm with the better vessels may be chosen.
When should I plan a fistula?
As early as possible once your kidney doctor expects dialysis. This gives time for the fistula to mature, and may avoid a catheter.
How long does the operation take?
Usually about one to three hours, depending on the type. Your surgeon will tell you what to expect for your case.
Does it hurt?
Anaesthesia keeps you comfortable during surgery. Some soreness and swelling afterwards are normal and ease with care and pain medicine.
Why can I not use it straight away?
The vein must widen and strengthen first. Using it too early can damage it, so we wait until it is ready.
What if my fistula does not mature?
Some do not. Scans find the cause, and a balloon procedure, a small repair, or a new access may help. Tell us early if something feels wrong.
How long will a fistula last?
Many last for years, but it varies. Regular checks and early treatment of narrowing help it last longer.
Can I do normal daily activities?
Yes. Avoid heavy lifting, tight bands and pressure on the access arm, and follow your team's advice on exercise and work.
Planning for dialysis access?
Get your arm veins mapped and learn which access is right for you.
Book an Appointment