Consent: Formation of an Arteriovenous Fistula

Note: This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines.

Overview of Procedure

An arteriovenous fistula is created for haemodialysis. This can be performed at several locations, with the aim to start distally in the non-dominant arm.

Typical procedures are radiocephalic, forearm, brachiocephalic, or brachiobasilic fistulae, however prosthetic grafts and leg grafts can also be used if necessary. The procedure involves mobilizing the vein and anastomosing this to a 7mm arteriotomy.

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage This can occur due to damage to either the artery or the vein or leak from the anastomosis, which can require a blood transfusion.
Injury to surrounding structures All dependent on the specific location of the fistula

 

Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain There is typically minimal pain experienced following this procedure.
Bleeding There is a small chance of bleeding and bruising in the fistula site post-surgery.
Infection Superficial wound infection is possible, although rare in this case. Peri-operative antibiotics will reduce the risk of wound and graft infections
Scarring This procedure will result in a scar, which can form as a keloid scar.
Seroma A swelling of lymphatic fluid may occur due to disruption of the lymph nodes and channels. Careful dissection of the lymphatic nodes and channels with ligation will minimise this risk.
Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Failure to mature This occurs in approximately 20% of cases, whereby the fistula will not form fully and not function. Ensuring optimum arterial and venous diameters, no additional vascular disease, and a meticulous technique.
Steal syndrome This is where too much blood travels through the fistula resulting in an ischaemia in the hand, as distal to the fistula. This may requiring tightening of the fistula, an alternative procedure, or removal of the fistula entirely.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery.

Late

Complication Description of Complication Potential Ways to Reduce Risk
Reintervention Occasionally fistulas will become narrowed, occlude, fail to mature, or result in steal syndrome, each requiring their own treatment.

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