Renal Access Surgery

Renal Access Surgery is required to prepare a patient for dialysis.

Dialysis treatment requires a faster than normal blood flow, which means the vein needs to be enlarged to facilitate this.

This is often achieved with an Arterio-Venous Fistula (AVF), which is a connection of an artery and a vein (most commonly in the lower arm or wrist) that allows blood to flow from the artery directly into the adjacent vein.

When the artery and vein are joined, the blood flows at a higher pressure, which causes the vein to enlarge and the vein wall to thicken. This makes it easier to insert the needles required for dialysis. The joining of the vein and artery is known as AV fistula creation.

If the patient’s own veins are not suitable, an artificial tube or ‘prosthetic graft’ made of a synthetic material can usually be used as an alternative.

It is not uncommon to experience aneurysms (ballooning) within the newly formed connection when an AV fistula is created, nor is it uncommon for the AV fistula to be affected by stenosis (narrowing). Both problems can be fixed with AV fistula angioplasty and stenting, however the fistula cannot always be preserved and it may become blocked. Regular surveillance of AVF prevents loss of fistulae and extends their lifespan.