When your doctor told you that your kidney function has decreased significantly and that you need to undergo dialysis to survive, you must have felt very scared and anxious. Not only that, but when he told you that you need to create a fistula in your arm before dialysis, many more questions must have come to your mind. You must be thinking things like, 'What is this fistula?', 'Is this a major operation?', 'What will happen to my arm after this?' Don't worry, this article is to answer all these questions that you have in your mind. We will talk about everything in a very simple and detailed way.
Simply put, what is a dialysis fistula?
It's very simple. A dialysis fistula is a minor surgical procedure that allows you to receive dialysis treatment easily and safely. In this procedure, a surgeon connects an artery and a vein in your arm. This is usually done in the arm you don't use the most (for example, your left arm if you are right-handed).
Think of it this way. When you have dialysis, your blood is taken from your body, cleaned by a machine, and then put back into your body. This requires a large amount of blood to be pumped back and forth per minute. Our normal veins (veins) can't handle that much blood flow, they're weak. So, when you create a fistula, the high pressure blood coming from the artery also gets a way into the vein, so that vein gets bigger and stronger over time. It's like replacing a small water pipe with a big, strong one. This is also called an arteriovenous (AV) fistula .
This fistula is the most appropriate and safest way to receive and return blood for dialysis treatment. It is the method with the lowest risk of blood clots and infection.
How do you prepare before fistula surgery?
This is not a major, scary surgery. It is a minor surgery that is usually completed within an hour or two, and you can go home the same day (outpatient procedure).
Before the surgery, your surgeon (usually a vascular surgeon) will talk to you about this and explain how the surgery will be performed. In addition, he or she will ask you the following questions:
- Your complete health history.
- You should definitely mention any medications you are currently taking (especially blood thinners like Aspirin and Clopidogrel ).
- About your allergies.
Then, the doctor will perform an ultrasound scan of your arm, look at the condition of the arteries and veins, and choose which veins are most suitable for surgery.
How and types of fistula surgery are performed
On the day of the surgery, the medical team will first give you a local anesthetic to numb your arm. So you won't feel any pain. Then, they will make a small incision, connect the selected artery and vein, and close the wound with dissolvable stitches.
There are several main types of fistulas that doctors use, depending on the location of the veins in your arm.
| Fistula Type | Simply location |
|---|---|
| Radiocephalic fistula | It is often performed on the wrist. |
| Brachiocephalic fistula | Performed slightly above or below the elbow. |
| Transposed brachiobasilic fistula | In cases where both of the above methods are not possible, it is performed using a vein on the inside of the arm. |
How to care for the fistula after surgery?
The most important time is after surgery. In order for the fistula to be used for dialysis, it needs to be 'mature'. This can take about 2 to 3 months . During this time, the vein gradually grows larger and stronger.
Do you feel the "thrill" of the fistula?
After the fistula is created, you will feel a slight vibration or a 'whirr' sound when you put your hand on it. It's like a little cat purring under your arm. Doctors call this the "thrill." Feeling this vibration means that your fistula is working well. You should check your hand every morning and evening to see if you feel this vibration. Make it a part of your daily routine.
The dialysis nurse will tell you to do exercises like squeezing a small rubber ball to strengthen the fistula.
Be sure to do these things to protect your fistula
Your fistula is a very valuable thing that can save your life, so it needs to be taken care of.
| Don'ts ❌ | Things to do (Do's) ✅ |
|---|---|
| Do not sleep with the arm with the fistula under your arm. | See if you feel the "thrill" every day. |
| Don't wear tight clothing, bracelets, or watches on that hand. | Wash your hands thoroughly with soap before dialysis. |
| Do not allow anyone to take blood pressure (BP) on the arm with the fistula for any reason. | Keep the wound clean. |
| Don't let them take blood from the veins of that hand. | Do the exercises advised by the doctor. |
Risks and when to see a doctor immediately
Although fistulas are very safe, complications can sometimes occur.
- Infections: Redness of the wound, swelling, severe pain, pus drainage.
- Thrombosis: In this case, a blood clot gets stuck inside the fistula. Then the "thrill" feeling disappears.
- Stenosis: Narrowing of the vein from the inside.
- Aneurysm: A weakening of the wall of a blood vessel, causing it to bulge like a balloon.
Most importantly: If the "thrill" you feel every day suddenly stops, it may mean that the blood flow in the fistula has stopped. It is an emergency! You should immediately call your doctor or go to the nearest hospital's Emergency Department (ETU) .
Frequently Asked Questions
Will the kidneys recover after dialysis?
No. Kidneys that have failed due to chronic kidney disease will not recover. The only way to stop dialysis treatment is to have a successful kidney transplant.
How long does a fistula last?
If you take good care of it, a fistula can last for years, even decades . That's the biggest advantage of a fistula.
We know that living with dialysis is a challenge. It can be physically and mentally exhausting. But remember, you are not alone. There are a lot of people, including doctors and nurses, who can help you. Talk to them openly about any questions, fears, or concerns you may have.
Take-Home Message
- A dialysis fistula is the best and safest access route for dialysis treatment.
- It is not a major surgery, but a minor surgery that usually takes 1-2 hours to complete.
- It is essential to check the sensation of the "thrill" at the fistula site every day after surgery. If it stops, see a doctor immediately.
- Under no circumstances should blood pressure be measured or blood drawn from the arm with the fistula.
- Taking good care of your fistula will save your life for many years.
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