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AV Fistulas and Grafts

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An arteriovenous (AV) fistula is a surgically created connection between an artery and a vein, which allows for increased blood flow through the vein for hemodialysis. An AV graft is a surgically-created tube made of a special plastic that joins together an artery and a vein for the same purpose. Regardless of whether you use an AV fistula, graft, or dialysis catheter for your hemodialysis access, it’s important to know how to care for it, and how to know when something is wrong.

Potential Complications With Your AV Fistula or Graft Access

Stenosis-Graphic

Stenosis/Narrowing

You may experience a problem with dialysis because your AV fistula has gradually stopped working as well as it once did. This is usually caused by tissue and cells that build up in your blood vessels, narrowing the vessel and creating a blockage, called a stenosisthe abnormal narrowing of a vessel. The blockage may be made up of scar tissue or blood clots which developed because the vessel became inflamed. Either way, the stenosis limits blood flow, which prevents you from undergoing successful hemodialysis.

Your doctor can verify AV fistula or graft dysfunction with a physical exam. One way is to place their hand on your skin to feel the blood flow in your AV fistula. Another way is to perform an angiogram or venogram. This means your doctor will use a machine to take pictures of your blood vessels to look for narrowing or blockage.

If your doctor confirms AV fistula dysfunction, they will determine whether a surgical procedure or minimally invasive endovascular procedure is the best treatment to re-establish blood flow in your fistula.

Below are some common treatment options to open a blocked AV fistula:

1. Percutaneous Transluminal Angioplasty (PTA):

  • After your doctor injects contrast dye into your AV fistula or graft to see the area of blockage, a specialized catheter with a balloon at one end is inserted.
  • Once the balloon is positioned correctly, your doctor inflates the balloon to open the blockage.
  • In some cases, the balloon sufficiently opens the blockage. In other cases, your physician may decide that other treatment options are necessary.
PTA diagram

2. Percutaneous Transluminal Angioplasty (PTA) and Drug Coated Balloon:

  • After your doctor treats you with a PTA balloon, he or she may inflate a second balloon in the same place where the first balloon was inflated.
  • This second balloon, coated with a drug called paclitaxel, helps to prevent scar tissue from building up around the blockage, which can keep your vessel open longer than PTA alone.
Drug coated balloon diagram

3. Percutaneous Transluminal Angioplasty (PTA) and Covered Stenting:

  • An alternative procedure your physician might choose is PTA with a covered stent.
  • Your physician will begin with needle entry in your AV access.
  • Your physician will then insert a catheter (thin tube) with a small balloon at the tip into the narrowed vein.
  • As the balloon is inflated it stretches the vein. The balloon is then deflated and removed from your body.
  • Next, a covered stent is inserted into your AV access and expanded to help keep your vein open.
  • A covered stent is a small metal mesh tube (stent), covered with a flexible material that is designed to keep the blocked area open.
  • Over time, your vein wall will heal around the covered stent as it continues to support the vein.
Stenting diagram

4. Thrombectomy/Thrombolysis:

  • Your physician will insert a catheter into your skin and direct it to the blood clot, also known as a thrombusa blood clot formed inside a vessel.
  • Then, he or she may physically remove it by:
    • Using a mechanical device to break up the clot (thrombectomy), which usually takes less than one hour, or
    • Injecting a medicine to dissolve the clot over several minutes (thrombolysis)
Thrombectomy diagram

5. Surgery:

  • A surgeon can operate on your blood vessels to remove the blockage around your AV access.
  • The blockage can be treated by using a new piece of AV graft material or with your native blood vessel in order to restore adequate blood flow to your AV access.
surgery diagram

What can I do to keep my AV fistula working well?

Treating a Fistula with PTA and a Drug Coated Balloon

Check of John's fistula access