MINT Hospital

AV fistula management: Systemic management of vascular entry for long-term hemodialysis

What is AV fistula

Why you need hemodialysis

Chronic renal disease
(Chronic renal failure)

Damaged or dysfunctional kidney
(persisting over 3 months)
End-stage renal failure

The condition deteriorates, making the kidney dysfunctional
Renal replacement
(Dialysis)
- ① Hemodialysis
- ② Peritoneal dialysis
- ③ Renal dialysis

If kidney (Excretion organ that excretes filtered wastes in the blood) is damaged or dysfunctional due to diabetes (50%),

polycystic renal disease, glomerulonephritis, old age, obesity, and hyperlipidemia for over 3 months, it is diagnosed as chronic renal disease (chronic renal failure) If the condition deteriorates and kidney becomes completely dysfunctional, it is called end-stage renal failure, and the most common practice for this occasion is hemodialysis.
Some of the blood is drawn out to dialysis machine to be filtered of waste and then put back into the body. It is conducted about 3 times (4 hours for each session) weekly.

Lifeline of hemodialysis patient. AV fistula

The blood vessels we originally have are difficult to have hemodialysis. Vein has thin wall and slow circulation, whereas artery is located too deep inside body and has strong blood flow, posing the risk of damage and bleeding.
To supplement weakness of vein and artery while keeping their advantage, dialysis vessel (AV fistula, AVF) is created by connecting nearby artery and vein.: _{(※ if your own artery is too weak, artificial vessel graft can be attached between artery and
vein to create AV graft (AVG))}

1 month after dialysis access surgery Blood vessels are living tissues that change and grow according to demand Artificial AV fistula becomes bigger and stronger, so dialysis is available after 1~3 months

AV fistula care

If you take care of your AV fistula like you would for potted plant, you may use it for long

Self-artery

2.83
years
Artificial graft

1.75
years

Average span of AV fistula

AV fistula, how long can I use it?

AV fistula is destined to get narrow over time. It is because

① High arterial pressure keeps irritating the fistula and
② Thick needle is inserted in and out repeatedly, which creates callus

If you do not treat narrowed (stenosed) fistula early, it may cause thrombosis and block (occlude) the fistula Problem with AV fistula is directly related to life of patient. Therefore, once AV fistula is made, it must be treated carefully for longer usage.

‘Healthy and Strong’ AV fistula management

By checking stenosis and thrombosis with following 3 methods,
you may find the problem with your AV fistula in early stage.

Frequent examination
with finger tip
Monthly blood flow
examination
Ultrasound every
3~6 months

Angiography every 6 months

Test that takes X-ray after injecting contrast into a thin catheter inserted at the fistula It is the most accurate test and is recommended when treating diagnosed stenosis. It reveals any narrowing, stenosis, thrombosis, and bypass of the fistula. Also, it accurately examines central vein that is connected

the heart which can’t be seen with ultrasound.

+ Details

Self-check

for abnormal signs of AV fistula

95% of the AV fistula with insufficiency like stenosis and obstruction can be recovered to normal with simple intervention.
But if the fistula is damaged by not treating the problem at early stage, only surgical treatment is available.

Therefore, if you are experiencing the symptoms below, you must visit hospital right away and have it treated at early stage.

1

Palpitation at the needle-puncture site

A healthy AV fistula gives a non-resilient vibration(vibrating sensation like being electrocuted).
2

Partial enlargement of AV fistula

It is when the vein becomes swollen and hard. In this case, there is possibility of thrombosis.
3

No bleeding when punctured with needle

It is because the fistula is narrow or obstructed. It is also a sign for stenosis when dialysis takes too long because the blood is not coming out.
4

Swelling in the arm, or consistent bleeding after dialysis

When the vein that leads to heart becomes narrow, the arm may become swollen and once the vein part in AV fistula gets narrow, the bleeding may persist after hemodialysis.

Major vascular problems that disrupt hemodialysis

See it in angiography

Stenosis

Stenosis’ where blood vessel gets narrow develops, making the blood to circulate in narrow passage.
Occlusion

If the stenosis is left untreated for long time and thrombus builds up, ‘obstruction’ where blood flow is blocked due to complete occlusion of the fistula occurs.
Thrombosis

Blood that did not flow out smoothly due to stenosing fistula whirlwinds and then coagulates like a jelly.
If time passes without treatment, the area develops ‘thrombosis’ where the fistula hardens.
Aneurysm

Excessive blood flow and occlusion at the upper section increases pressure in the fistula, making the fistula wall bulge and swell. It can cause other complications like cardiac failure, pain, bleeding, rupture, and thrombosis

+ AV fistula treatment

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