Consent: Arteriovenous Fistula Formation - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x 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, and the applicable and appropriate law in your jurisdiction governing patient consent. 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, brachiocephalic, or brachiobasilic fistulae, however prosthetic grafts and leg grafts can also be used if necessary. The procedure involves mobilising the vein and anastomosing this to a small 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. Frequent questions What is an arteriovenous fistula and why is it created? An arteriovenous fistula is a surgically created connection between an artery and a vein, primarily for haemodialysis access. It is typically formed in the non-dominant arm to facilitate efficient blood flow during dialysis. What are the common types of arteriovenous fistula procedures? The most common types of arteriovenous fistula procedures include radiocephalic, brachiocephalic, and brachiobasilic fistulae. In certain cases, prosthetic grafts or leg grafts may be utilised if suitable veins are not available. What are the potential complications associated with arteriovenous fistula formation? Complications can include haemorrhage, injury to surrounding structures, and infection. Other risks involve pain, bleeding at the site, scarring, and the possibility of blood clots, which can be mitigated with appropriate peri-operative care. How can the risk of arteriovenous fistula complications be minimised? To minimise complications, careful surgical technique, meticulous dissection of lymphatic structures, and the use of peri-operative antibiotics can be employed. Additionally, patients may receive anti-embolism stockings and low molecular weight heparin to reduce clotting risks. What is "steal syndrome" in the context of arteriovenous fistulas? Steal syndrome occurs when excessive blood flow through the fistula leads to ischaemia in the hand distal to the fistula. This condition may necessitate adjustments to the fistula, alternative procedures, or even complete removal of the fistula. Rate This Article