What are the possible things that can go wrong with my fistula?

Brian,

Fistula is your own vein. With proper care and use it can last for many years.

Major problems include:

1. Failure to mature. The fistula fails to enlarge enough for needle cannulation or dialysis at the necessary blood pump speed. This is an early complication. This can be treated before the fistula is ever used for dialysis or early on in the break in period. See post under fistula cannulation for more information on this issue.
fistula cannulation post

2. Infection is always a possible complication. Best way to prevent an infection is proper arm washing just prior to your hemodialysis treatment. Also proper skin prep of the fistula prior to and during needle cannulation. See DOQI Guidelines Infection

3. Stenosis in the fistula. Stenosis is the narrowing of the vein. It can occur at the site of the artery connection to the vein (anastomosis) within the fistula or any where in the vein from the fistula back to the heart. The narrowing causes a decrease in the access blood flow rate (speed of the blood flowing within the access itself). The fistula must have a higher access blood flow than the blood pump speed of the hemodialysis machine or recirculation and poor dialysis results. NKF DOQI Guidelines about stenosis

4. Low access blood flow as noted in number three.

5. Aneurysm formation can occur. An aneurysm is an abnormal dilatation of the blood vessel and can lead to a weakness in the vessel wall. Aneurysm formation can be avoided with proper cannulation site rotation. (Only exception is the buttonhole technique and information on buttonhole technique is listed under Buttonhole Cannulation for AVF.)

6. Clotting or thrombosis of the fistula can occur. A fistula can clot after any event that creates a low access blood flow within the fistula. More information is covered under the post �Removing Pressure Dressing�.


A fistula than matures will suffer many fewer complications than any other current form of vascular access. That is why a well functioning fistula is the gold standard for vascular access.

Please post any further questions; this is a very basic overview.

Deborah


[Note: This message has been edited by Deborah Brouwer]