Vascular access comes in three main varieties. Arteriovenous fistulas and AV grafts are two of them that are intended for long-term use. The venous catheter is the third kind, which is used temporarily.

Arteriovenous Fistula Surgery
An artery and a vein are connected to form an AV fistula. In order to safely administer hemodialysis treatment, the vein is dilated and expanded during surgery. Because it offers adequate blood flow, lasts longer than other types of access, and is less likely to become infected or blocked during therapy, the AV fistula is advised above other types of access.
Before the AV fistula can be used for dialysis, it must first form and mature for at least two to three months. The patient must undergo the operation again or select an alternative if the fistula does not mature.

Arteriovenous Graft Surgery
In contrast to a fistula, an AV graft joins the artery and vein with a man-made plastic tube. The graft is looped, with one end attached to an artery and the other to a vein. When the patient doesn’t have enough time to wait for an AV fistula to develop, this surgery is preferred. After surgery, the AV graft is often ready for usage two to three weeks later.

Venous Catheter
The use of a venous catheter is the third method for gaining vascular access. The tube is put into a vein in the neck, chest, or area close to the groyne. A sizable central vein connects the tube to the body. The catheter is guided into the desired vein using fluoroscopy, a form of X-ray. This approach is used when the patient may not have enough time to have an AV fistula or graft placed because the kidney disease is progressing too quickly. The venous catheter will be used for a few weeks or months, but eventually dialysis will require a long-term vascular access operation.

All AVF for dialysis shares a lot of the same traits. They were all made utilising natural materials and non-synthetic containers. The three fistulas for dialysis that are most frequently made are:

1: Radial Cephalic Fistula
This kind of fistula is extremely challenging to form. For anastomosis, the radial artery and cephalic vein are joined. Compared to the other two forms, the radial cephalic fistula has a lower blood flow, but it better protects the arm vessels. The initial option for hemodialysis access is typically this.

2: Brachial Cephalic Fistula
The cephalic vein in the upper arm is used to generate this sort of fistula by joining it to the brachial artery. The fistula is simple to form because the blood arteries in the arm are bigger. It typically requires less dissection and has a wider range of potential cannulation sites. During dialysis, the brachial cephalic fistula allows more blood to pass via the blood arteries but also increases the risk of steal syndrome.

3: Brachial Basilic Fistula
To acquire stable vascular access with this type of arteriovenous fistula, the vein must be raised and transposed. A deep vein that has been mobilised and a superficial artery are connected. Although it can be conserved more effectively than other fistulas, it also has a greater rate of patient morbidity. Patients who have repeatedly failed access procedures are more likely to develop it.

The preparation a patient does can enhance the results of the surgery. Therefore, it is essential to be fully prepared before having the treatment.
In relation to your medical history and current medications, please respond to all of the doctor’s questions. This includes over-the-counter medicines, prescription pharmaceuticals, herbal remedies, and vitamins.
To improve your general health, alter your diet as needed and strive to shed extra pounds.
High blood pressure should be under control, as this can increase the risk of AV fistula surgery problems.
Prior to the procedure, wait 6 to 8 hours before eating or drinking.
Avoid smoking at all costs since it weakens blood vessels and slows healing.
Before beginning the dialysis treatment, take any drugs your doctor has given exactly as instructed.

An expert vascular surgeon performs the AV fistula surgery in an outpatient setting at a hospital. As soon as the surgery site has been cleaned, anaesthesia will begin. Depending on the patient’s condition, general, local, or regional anaesthesia may be utilised.
The procedure will be carried out in the manner described below.
– Following the onset of the anaesthetic, the area is cut.
The chosen artery and vein are located, and the blood flow via the selected blood vessels is momentarily stopped.
Through the use of stitches, the artery and vein are connected together without the use of any external support, restoring blood flow.
After that, the wound is stitched up, and the fistula is allowed to develop over the following few months.

The patient is moved to the observation room right after following surgery. Following the administration of general anaesthesia, a tube may be inserted in the windpipe to regulate breathing.
For the following few hours, the surgical team will keep an eye on the patient’s vital signs and other important bodily processes. The patient is given the all-clear to go once everything is in order. The doctor gives you a recovery plan that includes dos and don’ts following the surgery before you leave the hospital.

There won’t be a lot of external modifications. The swollen vein that will be used for access to the dialysis machine will be visible to the patient internally. The blood vessels can also be felt to have a pulse.

In India, AV fistula surgery can cost anywhere between 80,000 and 1,50,000 rupees. The following variables could affect the price in different ways. –
difficulty of the process (veins used to create AV fistula)
Surgical fee
diagnostic procedures
Risks and difficulties
the cost of anaesthesia
costs associated with hospitals
Care after surgery and follow-ups