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Failed arteriovenous fistula and what you need to know Sometimes, even when you take the best possible care, there are times when an arteriovenous fistula fails. While this can certainly be frustrating for the patient, fortunately there are a variety of different treatment options. For failure of the arteriovenous junction.
Facts about dialysis connections as recommended by vascular surgeons
Guide to the arteriovenous connection for hemodialysis patients
Failed arteriovenous graft
The sooner a fistula can be repaired, the faster you can resume dialysis treatments as usual, so you can stay healthy and feel better.
If the fistula can’t be repaired, your doctor may suggest setting up a temporary access so you can receive dialysis while your medical team works to restore your fistula.
Let’s explore some of the causes of AV failure as well as some potential treatment options.
Causes of stenosis of the arteriovenous junction in hemodialysis
Reasons for the failure of the arterial graft
An arteriovenous fistula can fail when there is a narrowing, also called a stenosis, in one of the blood vessels associated with the fistula.
When stenosis occurs, the volume and rate of blood flow can decrease, and you may not be able to adequately dialysis.
A fistula can also fail if a blood clot forms in a vessel and blocks blood flow, which may prevent dialysis with an arteriovenous fistula completely.
Treatment options for failed venous fistula surgery
- pharmaceutical
- Thrombectomy (thrombectomy)
- Angioplasty with or without stents
- Surgical reviews of arteriovenous fistulas
- Surgical creation of a new fistula
When an arteriovenous fistula fails, the sooner you treat the fistula, the better the outcome.
Keeping you working well will help you get the most out of dialysis, and help you feel healthier.
Depending on your particular case, there are a few treatment options for a failed fistula.
pharmaceutical
If an arteriovenous fistula breaks or fails due to the presence of blood clots, your doctors may suggest certain medications depending on the severity of the clots.
Some medications can help dissolve blood clots so the fistula can function properly again.
These types of medications may be used alone, or in combination with procedural approaches as described in more detail below.
thrombectomy
Another option is to restore the function of the arteriovenous fistula through a procedure called thrombectomy. This type of procedure can be completed in the hospital or on an outpatient basis.
During a thrombectomy, the doctor makes an incision in the blood vessel and passes a small line called a catheter to the site of the clots.
Once the catheter is in place, the clot can be dissolved by delivering medication directly to the clot. This is called clot dissolution.
Alternatively, the doctor can also place a mechanical device at the site to manually remove blood clots. This is referred to as Thrombectomy.
Angioplasty with or without stents
If the narrowing or blockage is causing the fistula to fail, angioplasty is another type of procedure used to open blood vessels and restore blood flow. This procedure is often performed under local anaesthesia.
The procedure is done through:
- Inserting a thin tube, called a catheter, through a small hole in the access arm.
- The catheter is then passed through your blood vessels until it reaches the area of the narrowing or blockage.
- Once in the appropriate position, a small balloon located at the end of the catheter is inflated, pushing the clots up against the vessel walls and opening the vessel to restore flow.
- After the narrowed or blocked area has been successfully expanded, the balloon is deflated and removed.
Surgical reviews of arteriovenous fistulas
In some cases, a small surgery may be performed. Before it is performed, a variety of radiological tests are done to make sure that the doctor is in need of this surgery.
Create a new fistula
If the fistula can’t resume function through medication, angioplasty, stenting, or surgery, your doctor may suggest creating a new arteriovenous fistula.
If the doctor decides it’s best to create a new vascular port, he or she will create it in a place in the arm above the old fistula.
If this is not possible, your doctor may want to use the other arm if the vessels fit in it, or he may consider creating a fistula somewhere else in the body, such as the leg.
If you need a new fistula, this will take a long time Central venous catheterization (CVC) Temporary so as not to be interrupted from dialysis sessions.
The difference between fistula and graphite and which is better for a dialysis patient
Possible early signs that the Vistula may fail
- Disappearance of tremor or pulsation above the junction
- Redness, warmth, or swelling at the junction site
- Any pus secretions or anything coming out of the junction
- Inability to move the fingers on the arm with the joint
- Recommended exercises to improve the chances of developing a normal arteriovenous junction
- Monitoring your fistula during dialysis to make sure that proper blood flow rates are being met
You must follow up and pay close attention to the arterial bypass operation because it is considered the life of any defect in it that may affect your dialysis treatment
Sources:
(i) National Kidney Foundation. (And the). Access to dialysis: what you need to know. Retrieved on September 10, 2019 from https://www.kidney.org/sites/default/files/11-50-0216_va.pdf
(ii) University of Rochester Medical Center. (And the). Surgical thrombectomy. Retrieved on September 10, 2019 from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=135&contentid=372
(iii) Radiology Info. (23 January 2019). Hemodialysis and fistula/graft removal interventions. Retrieved on September 10, 2019 from https://www.radiologyinfo.org/en/info.cfm?pg=dialysisfistulagraft.
(4) Radiology information. (February 26, 2019). Angioplasty and vascular stenting. Retrieved September 10, 2019, from https://www.radiologyinfo.org/en/info.cfm?pg=angioplasty.
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