For patients with kidney failure who require hemodialysis, an arteriovenous fistula serves as a vital lifeline -- and arteriovenous fistuloplasty is a life-saving procedure.

In cases of end-stage renal failure, where the kidneys can no longer function properly, patients must undergo dialysis to remove waste and excess fluid from the body. One of the first steps in preparing for dialysis is creating a blood vessel suitable for repeated access.

"Since it is difficult to dialyze blood through normal veins, it is necessary to create a dialysis vessel called an arteriovenous fistula that is thick and has high blood flow. The surgery for this is arteriovenous fistuloplasty," said Professor Choi Eol of the Department of Vascular Surgery at Soon Chun Hyang University Hospital Bucheon.

An arteriovenous fistula is a way to connect an artery and a vein to create a blood-rich passageway. Initially, dialysis can be started temporarily by inserting a jugular venous catheter, but the risk of infection makes it difficult to use it for an extended period.

For this reason, most patients undergo arteriovenous fistuloplasty to stabilize hemodialysis. Arteriovenous fistuloplasty can be performed on both arms or both legs, but due to complications and longevity, the arms are usually considered first.

The surgery starts with an ultrasound scan to select the appropriate vessel, then a skin incision is made under partial anesthesia to connect the artery and vein. There are two types of arteriovenous fistulas: autovascular arteriovenous fistulas, which connect directly to the patient's own blood vessels, and artificial arteriovenous fistulas, which use artificial blood vessels to connect the arteries.

Autovascular arteriovenous fistulas have a lower risk of infection but require six to eight weeks for vessel maturation. In comparison, artificial vessels can be used relatively quickly after about four weeks, but the risk of infection and vessel occlusion is higher than autovascular fistulas. If the existing blood vessels are in poor condition, reoperation may be necessary because the vessels are not thick enough, or additional procedures may be needed to help the vessels mature. Surgery usually allows patients to go home the same day as surgery if there are no acute complications.

Careful management is essential for arteriovenous fistulas

The most important aspect of an arteriovenous fistula is postoperative care. Because autovascular arteriovenous fistulas require the blood vessels to become thick and strong enough to pierce a dialysis needle, it is recommended that patients perform gentle hand squeezing and stretching exercises or squeezing and stretching a rubber ball at least five times a day.

Patients should also avoid taking blood pressure, drawing blood, or giving themselves intravenous fluids on the operated arm, and avoid resting on their arm or arm pillow, lifting heavy objects, or wearing tight sleeves or bracelets. Any damage to the blood vessels can lead to excessive bleeding, so extra care must be taken.

A normal arteriovenous fistula feels like a buzzing vibration when touched. If the vibration disappears or if patients experience swelling and pain in their arm, they should visit a doctor immediately. This could be a sign of something wrong, such as a narrowing or blockage of the blood vessel or an infection.

With prolonged use, arteriovenous fistulas can become narrowed or blocked. In this case, percutaneous angioplasty or thrombectomy can be performed to fix the problem, or a new arteriovenous fistula can be created if necessary.

“An arteriovenous fistula is not just a blood vessel but a lifeline for patients with end-stage renal failure,” Professor Choi said, “A thorough postoperative management is the key to the success of dialysis treatment.”