Renal (Dialysis) Access

Arterio-venous fistula (AVF)

An AV Fistula is important for patient’s who may require haemodialysis due to kidney failure. Patient’s who start dialysis using a autogenous (their own) AVF have been shown to have a much better outcome than if starting with a prosthetic line. Therefore whenever possible a 'fistula-first' recommendation has been adopted across the world. Your renal physician will refer you to a vascular surgeon such as Dr Vivienne Moult for AVF creation if they believe you may need dialysis in the future. 

An AVF involves connecting a vein to an artery which forms the fistula. Over time the vein becomes ‘arterialised’ with much more blood flow through the vein than usual, which causes the vein to dilate (become larger) and the wall of the vein to thicken slightly (becomes stronger). When this successfully happens it is called ‘maturation’ of the fistula, which means that it is ready to be used for dialysis, and can support the blood flow and pressures that are required on the dialysis machine. 

Sometimes if the fistula does not mature, it may need a further procedure such as a fistuloplasty, which is a ballooning of a narrowed or diseased segment of the fistula. AV Fistula's may also at times develop scarring or narrowing along the vein which may compromise blood flow and thus the fistula’s ability to be used for dialysis. This may require fistuloplasty (ballooning) to treat or rarely may even require further surgery. 

Dr Vivienne Moult is able to provide the full range of renal access surgery for haemodialysis including all types of AVF creation, fistuloplasty, any open surgical revision should it be required.