Arteriovenous fistula (AVF) ?
The superficial veins do not have sufficient flow to allow haemodialysis. For this reason, the surgeon must create an arteriovenous fistula (AVF) under local anaesthetic. This involves connecting a vein to a nearby artery, so that some of the arterial blood is diverted into the vein. The vein will dilate under the effect of the blood pressure, providing sufficient blood flow for easy puncture. A vein in the forearm or upper arm is most often chosen, preferably on the "non-dominant" arm (i.e. the left arm for right-handed people and vice versa), which is less used in everyday life. The time taken for it to develop varies from a few weeks to several months. The fistula must be created early enough to ensure that it is well developed by the time dialysis is required.
Puncture may be difficult at first, but should improve within a few weeks. The pain associated with puncture is reduced or eliminated by applying a local anaesthetic to the skin (cream or self-adhesive patch) at home at the puncture site one hour before the dialysis session.
Complications may arise over time (overdevelopment, malfunction, clotting, etc.), requiring one or more surgical operations or additional investigations (X-rays, ultrasound, etc.).
Precautions must be taken to ensure its longevity. The following should be avoided
A vascular prosthesis?
There are several types. The most common is made of goretex (PolyTetraFluoroEthylene). This is a flexible tube inserted between an artery and a vein in the forearm, upper arm or thigh. Unlike arteriovenous fistulas, it is quicker to use (2 to 3 weeks). However, it malfunctions more frequently and does not last as long. It is only used if an arteriovenous fistula is not possible. It is inserted under general anaesthetic in the operating theatre by a vascular surgeon after a surgical and anaesthetic consultation. The blood vessels may be identified beforehand using Doppler ultrasound. The preferred site is the "non-dominant" arm.
How is the arteriovenous fistula punctured?
Two punctures are needed in the fistula, using large-bore needles to facilitate blood flow:
- An arterial needle is used to aspirate the blood to be purified,
- A venous needle is used to reinject the purified blood,
These two needles are connected to the extracorporeal dialysis circuit, which in turn is connected to the dialysis generator.
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