A fistula is an abnormal connection between organs, but when it comes to nephrology, fistula maturation is necessary for the hemodialysis process. Fistulas can occur in three areas. In most cases, fistulas occur naturally and must be repaired. Arteriovenous fistulas are an abnormal connection between arteries and veins. In the case of hemodialysis, these fistulas are man-made. Once a surgeon creates a fistula, they cannot start dialysis immediately. It takes time for the maturation process. If you try to do dialysis with a fistula that is not mature yet, it will not work properly. Fistula maturation and repair is a very important aspect of nephrology.
Fistulas are typically very uncomfortable and not something anyone wants to have. Fistulas occur between three sets of organs. The first set is the skin and anus. The second set is the rectum and vagina. The last set is an artery and vein. Fistulas between an artery and vein are referred to as arteriovenous fistulas. I am sure you can see how a connection between the vagina and rectum or anus and skin is abnormal. You probably think it is normal to have a connection between an artery and vein. They are a part of the cardiovascular system. What you may not have known is that arteries and veins are not directly connected at all. Blood flows naturally from the artery to the capillaries, and then the vein.
An arteriovenous (AV) fistula allows for blood to bypass the capillaries. The problem that occurs in AV fistulas is that it causes the tissues below the area to lose blood. Sometimes these things naturally occur in the legs, but surgeons can create them. Symptoms can begin to occur if the AV fistula is not monitored or repaired. Symptoms include bruising, swelling, and fatigue. Even though there are major risks, making an arteriovenous fistula has major benefits in dialysis.
AV Fistula Procedure
When it comes to hemodialysis, a surgeon has to go in and create an AV fistula. When you are on dialysis, the vein can become damaged from the constant insertion of the needle. Creating an AV fistula only makes it easier for dialysis to take place. The surgeon goes in and makes the vein wider by connecting it to a nearby artery. Arteries are the largest of blood vessels and help with blood flow efficiency. These fistulas can be made in many areas, but the forearm is typically the best. There are also things a physician has to look at before doing the procedure. The most important thing is the health of the vein and artery. The surgeon cannot use a vein or artery that is narrow and have other problems like plaque build up. These problems will limit the amount of blood flow for dialysis. The size of the vessel is also important. The vessels have to be a certain length and have a certain diameter. If the vessel does not meet the requirements, it cannot be used.
AV Fistula Maturation
Once the procedure is over, the maturation process occurs. It takes anywhere from six to twelve weeks for the vein to mature to the point it can be used for dialysis. The maturation process requires vascular changes. There is a slight change in blood flow; therefore, the blood vessels have to adjust to these changes. It takes time for the vein to get the proper amount of blood flow. Without enough blood, dialysis is no good. The vessel also has to grow. The diameter of the vessel has to be wide enough. The vessel also has to thicken up. If the blood vessel is too thin, it will burst. Once the vessel reaches the appropriate thickness and width, it is considered mature. Now dialysis can proceed through that vein.
AV Fistula Repair
There are times where the vein has to be repaired. It is important for the physician to keep an eye on the veins. As stated earlier, if there is a need for repair, you will begin to have certain symptoms. When it is not monitored close enough, your complications could involve heart failure, blood clots, and internal bleeding. You will have symptoms before things get too bad. If the created AV fistula is causing too many problems, the surgeon may repair it and try with another set of vessels.
Fistula maturation is imperative in the process of hemodialysis. When you have severe kidney problems, hemodialysis is sometimes your last resort. AV fistulas are not typically a good thing, but in the case of hemodialysis, it is necessary. Veins tend to scar and damage with dialysis. Making a fistula between the vein and artery allows for the surgeon to change the vein in which your dialysis goes through. If you are suffering from kidney disease, ask your doctor about hemodialysis through an AV fistula. It could help preserve your veins during treatment.
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