Arteriovenous Fistula

An Arteriovenous fistula (AVF) is surgically placed for dialysis access and is considered the gold standard for maintaining access to one’s circulatory system to provide life-sustaining dialysis.  An AVF is surgically made by connecting an artery to a vein directly, most commonly in the arm.  An artery contains oxygen rich blood flowing at high pressure away from the heart.  Veins are larger vessels with low pressure containing de-oxygenated blood to the heart.  In an AVF, the blood flows directly from a large artery in the arm into a large vein.  After the artery and vein are connected, the vein grows larger due to the flow making it easier for a dialysis nurse to access the vessel with a needle, this is termed “maturation” of the AVF.  Once matured, two needles are placed into the vein for dialysis. One needle is used to draw blood and run through the dialysis machine; the second needle returns the cleansed blood. AV Fistulas can remain patent and used for dialysis for several years, but they can occasionally clot due to poor flow or narrowing of the vessels in the AVF.  Interventional radiologists monitor AV fistulas to avoid complications such as infection, blockage from clotting and poor blood flow. Interventional radiologists also keep AV fistulas or other accesses open or unclogged through minimally invasive techniques such as angioplasty or stenting. These interventions are safer, less costly and equally effective than surgery, and they improve the quality of life for dialysis patients.