Arteriovenous Graft Creation for Hemodialysis

Introduction

In kidney failure, kidneys cannot filter waste and extra fluid from the blood. In such events, dialysis is used to remove them. Arteriovenous (AV) graft surgery is performed to get an artificial access point into the vascular system for dialysis. Blood flows from the body to the dialysis machine during AV graft surgery and back into the body after filtration. An artificial tube or graft is used during AV graft surgery to join the vein to the artery. Typically, synthetic material is used to create grafts. Surgeons may occasionally use animal or human blood vascular tissue as a graft.

What Is Dialysis?

Every day, a kidney may filter between 100 and 150 quarts of blood. As a result, waste builds up in the blood if the kidneys are not working correctly. This may cause coma and even fatalities in the patients. Dialysis is used to treat such conditions and eliminate wastes from the body. In addition, it helps in the preservation of the equilibrium of the body in the following ways:

• Dialysis regulates blood pressure.

• It removes extra water and metabolic waste in the body.

• Prevent the accumulation of dangerous salts like sodium, potassium, and bicarbonate.

• Dialysis is performed on patients with severe renal failure or grave kidney damage; both are critical kidney disorders. It is necessary when the kidneys lose 90 percent of their effectiveness or cannot work to their total capacity.

• Kidney failures are permanent; treatment may last for months or even years.

What Body Part Receives an Arteriovenous Graft?

The graft is typically placed in the arm but can also be placed in the leg. An artificial hollow tube ("graft"), an AV graft, connects an artery and a vein. The line connects to the artery on one end and a vein on the other.

How Durable Are Arteriovenous Grafts?

Grafts typically survive for two to three years but can last longer.

What Is the Requirement for an Arteriovenous Graft?

In addition to a complete dialysis treatment regimen, the doctor may advise arteriovenous graft surgery for renal failure. Permanent or temporary dialysis may be necessary for renal failure patients. Timely treatment of underlying causes, such as a drug overdose, shock, or kidney infection, can occasionally restore acute kidney failure.

People who require long-term dialysis due to irreversible renal impairment or narrow or poor blood arteries frequently undergo AV graft surgery. AV graft patients may also be kidney transplant candidates. If a person has kidney failure, the doctor may advise AV graft surgery because of the following:

• Autoimmune illnesses that affect the kidneys, such as systemic lupus erythematosus (a disorder that causes impairment in the kidney).

• Several genetic conditions, such as polycystic kidney disease, which results in kidney cysts that harm renal tissue,

• Conditions like shock and renal artery stenosis (narrowing of renal blood vessels) limit blood flow to the kidneys.

• Inflammatory diseases of the kidney, such as glomerulonephritis and nephritis.

• Infections include recurrent urinary tract infections, kidney infections, or septicemia (blood infection).

• Renal cancer.

• Medication use or misuse, such as intravenous (IV) abuse, taking excessive amounts of drugs, or using drugs for an extended period, including nonsteroidal anti-inflammatory drugs (NSAIDs).

• Poorly managed chronic conditions like diabetes and high blood pressure can harm the kidneys.

• Urinary tract blockages include kidney stones, tumors, congenital (present from birth) deformities, and prostate gland enlargement.

What Are the Preparation Before Arteriovenous Graft Surgery?

The doctor will do a particular examination and recommend tips to promote easy healing after surgery:

• The doctor will take a detailed oral and documented medical background of current medications. This covers prescription medications, over-the-counter medicines, herbal remedies, and vitamins. Medical history includes current patient health issues, previous operations, prescriptions, and allergies.

• Blood tests, specialized kidney tests, a chest X-ray, an electrocardiogram (EKG), and other tests as and if required as a part of preoperative testing.

• Before the procedure, shedding extra pounds with a balanced diet and exercise routine is recommended.

• The patient should discuss pre- and post-operative blood pressure management with a doctor. Good blood pressure management can reduce the risks of problems after AV graft surgery.

• Not consuming food or liquids as prescribed immediately before surgery.

• The patient may be advised to be nil per os or nothing by mouth before the surgery. The surgery may be postponed if the patient eats or drinks before the operation because this increases the risk of choking on stomach contents while under anesthesia.

• The patient was advised to quit smoking as soon as they could. A few days of abstinence can be helpful and aid in better healing.

• Before surgery, specific activities to avoid and dietary and lifestyle guidelines must be followed.

• Patients should inform the doctor if they are nursing or pregnant.

What to Expect on Arteriovenous Graft Surgery Day?

On the day of an AV graft operation, the patient can expect the following:

• The nurse or the dialysis technician will check and ensure that all required tests have been completed. The nurse or technician will provide the patient understands and signs the surgical consent paperwork. It is crucial to confirm with the operating team the proper surgical location and solve any other related queries.

• The patient should take off all jewelry and clothing. All jewelry and valuables should be left at home or with a family member. Sterile hospital gowns are provided.

• A patient should discuss medical history and the type of anesthesia they will get with the anesthesiologist (a doctor who gives anesthesia) or nurse anesthetist.

• A member of the surgical team will begin an intravenous line.

• The anesthesiologist will then give the anesthesia.

• A patient's airway may be protected and controlled with a tube during general anesthesia.

• The surgical team will monitor all body's vital signs, such as heart rate, breathing rate, blood pressure, and pulse. This continues until the person is awake, breathing normally, and the vital signs have stabilized.

How to Perform Arteriovenous Graft Surgery?

1. Selection of Surgical Site - AV grafts are typically created in the arm, although occasionally, they can be on the thigh. The surgical team will clean and sterile the surgical site.

2. Anesthesia - The anesthetist will administer the anesthesia. Surgeons frequently do AV graft surgery under local anesthesia. The type of anesthesia is dependent on the following

• Local Anesthesia entails injecting an anesthetic to numb the skin and surrounding tissues during surgery.

• General Anesthesia consists of intravenous (IV) drugs and breathing gases that will sedate the patient. The patient will be unaware of the procedure and experience no discomfort.

• Regional Anesthesia - Another name for regional anesthesia is a nerve block. It entails administering an anesthetic via injection near specific nerves to numb a portion of the body. Sedation with regional anesthetic will likely keep the patient at ease and comfortable.

3. Incision and Graft Placement - The surgeon makes an incision and uses a synthetic tube (graft), a transplanted animal or human blood vessel, or both to join an artery to a vein.

What Are the Complication Associated With an Arteriovenous Graft Surgery?

Arteriovenous (AV) graft surgery has risks and potential side effects, just like any other surgery. An AV fistula, in which the artery and vein are joined directly and without a graft, has fewer difficulties than an AV graft. However, in some instances, AV graft complications can be significant and fatal. They can also happen during surgery, healing, or at any time.

• Anesthesia side effects such as allergic reactions and respiratory issues.

• Excessive bleeding can result in shock.

• In particular, deep vein thrombosis (formation of a clot in a lower leg vein).

• Other issues include a blood clot that forms in the AV graft and obstructs blood flow. To fix or replace the graft, further surgery may be necessary.

• Infection of the transplant or the surrounding skin and tissues.

How to Reduce Complications Associated With Arteriovenous Graft Surgery?

• Patients should follow their treatment plan to lower the chance of associated problems.

• Experiencing a "buzzing" feeling at the graft site indicates that a blood clot may be present. It is advised to go to the emergency room right away or make a call to their doctor.

• Maintaining constant cleanliness at the AV graft site.

• Medical staff should not take blood pressure measurements or draw blood from the AV graft arm.

• Avoid wearing jewelry or clothes too tight or sleeping on the arm.

• Notify the doctor immediately with any concerns, such as bleeding, fever, increased pain, redness, swelling, or drainage from the cut.

• Avoid AV graft damage by lifting heavy objects with the AV graft arm.

Conclusion:

An AV graft is chosen for long-term hemodialysis vascular access if it is congruent with the patient's end-stage kidney disease (ESKD) life plan, overall healthcare goals, and the patient's circumstances allow for its development. Vascular surgeons and interventional specialists are experts at designing, implanting, and caring for dialysis accesses. Outpatient vascular centers undertake minimally invasive AV graft placement procedures. The procedure is done with the patient's quality of life and expectation.