Risks of AV Fistula Procedure

While AV fistulas are considered to be the safest and longest lasting of access types, and are generally agreed about by experts in the field to be the preferred type of vascular access, as with all medical procedures there are risks to the AV fistula procedure that must be taken into consideration.

Surgical risks of AV fistula procedure:

• Ischemia – Sudden lack of blood flow to the hand or foot (depending on AVF location), more likely in the elderly and in patients suffering from diabetes.
• Venous Hypertension – High pressure in the veins, due to venous insufficiency (blood leaking from valves) or obstruction to the veins (more common with side to side anastomosis procedure).
• Hemorrhaging, low venous flow or hematomas – As a direct result of the AV fistula procedure and immediately after it.

Complications and risks due to AV fistula procedure:

• Infection – Accounting for 20% of all AV fistula procedure complications. Most infections manifest as swelling, redness of skin and inflammation at the vascular access site and are easily treated. Other infections may need surgical intervention and drainage.
• Thrombosis due to blood clots – The AV fistula can cause blood clots to form, leading to deep vein thrombosis. Symptoms include severe pain at the site of thrombosis, palpitation at the AVF site, tremors and absence of feeling. Thrombosis and blood clots may also lead to a stroke.
• Stenosis – Difficulties in cannulation, painful edema (swelling), prolonged bleeding after cannulation or after removal of dialysis needles. Stenosis may obstruct outflow from the veins.
• Congestive heart failure – Causing shortness of breath and edema, increased intensity of the pumping may weaken the heart muscle and cause heart failure.
• Ischemic neuropathy – Severe pain, sensory loss, weakness of hand and fingers (or leg, depending on location of AV fistula), paresthesia (sensation of tingling, tickling, pricking, or burning and paralysis of muscles). Ischemia is also known as “steal syndrome”. The risks are especially high in elderly patients and patients suffering from diabetics. Clinical signs include reduction of movement to the wrist, coldness of the hand, color change and pain. The syndrome typically develops within hours of AV fistula procedure.
• Aneurysm – Enlargement of the blood vessel wall, resulting from repetitive puncture due to the AV fistula procedure. If there is a risk of perforation or ulceration, surgical intervention is recommended.
• Bleeding – Arteriovenous malformations may cause interior bleeding.

Minimizing the risks of AV fistula procedure:

Although AVFs have the least risk factors of all dialysis access methods, and are considered to be the preferred method of gaining vascular access, there are risks involved.

Use of Laminate Medical Technology’s VasQ™ can minimize risks by improving maturation and patency rates of AV fistulas, by providing external support thereby addressing the root causes of fistula failure.

Knowledge about potential complications allows for minimizing risks, proper AV fistula care and monitoring, and early intervention if needed.