Creation of an arteriovenous fistula for haemodialysis

Haemodialysis needs a high blood flow that ordinary veins cannot provide. The arteriovenous fistula is the best access for dialysis: by connecting an artery directly to a vein in the arm, the surgeon sends a stronger flow of blood into the vein, which makes it wider and thicker. It can then be needled at each session. The operation is done through a small incision, at the wrist (radiocephalic fistula) or at the elbow crease (brachiocephalic or brachiobasilic fistula), most often under local anaesthesia or an arm block. The surgeon stitches the vein to the side of the artery. When the veins are too small or damaged, a synthetic graft can connect the artery to a vein further away. The fistula is ideally created several months before dialysis is expected to start, as it needs to "mature" for a few weeks before it can be used. The non-dominant arm is generally chosen, and the veins of that arm should be preserved (no blood tests or drips). At Clinique Pasteur Tunis, the fistula is created in the operating theatre, usually as day surgery, in coordination with the patient's nephrologist and dialysis centre.