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Q. What are the recommended options for AV fistula placement?

Answered by
Dr. Abhinav Gupta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 26, 2020

Hello doctor,

This query is for my father in law aged. He is 58 years old and is diabetic and currently under medication for BP also. He has a history of two major heart attacks. In the last five years, he did not have any major heart issues.

Recently due to extensive amount of medications taken for a long time, he started showing signs of high amount of creatinine (currently 6.9). We did a few dialyses. Now doctors have advised doing an AV fistula on his left hand. His left hand is partially amputated from a previous septic shock treatment about four years back. His right hand is fine but an AV fistula there might terribly limit his movements and self-care. We wanted a medical opinion about where the fistula can be placed or can it be near to chest area as an alternate option?

Dr. Abhinav Gupta

Diabetology Nephrology
#

Hi,

Welcome to icliniq.com.

There are three main types of AVF (arteriovenous fistula). The radiocephalic fistula is a forearm fistula created by anastomosing the side of a radial artery to the end of a cephalic vein. It is also referred to as the Brescia-Cimino fistula. The brachiocephalic fistula is an upper arm fistula created by connecting the side of a brachial artery to the end of a cephalic vein or slightly central to the level of the elbow. Finally, the brachial artery–to–transposed basilic vein (BTB) fistula is another upper arm fistula. This fistula is created by anastomosing the side of a brachial artery to the end of a basilic vein that has been transposed laterally and elevated superficially to make it amenable to dialysis cannulation. Other sites could be leg also.

I advise you to discuss it with your doctor. The patient requires dialysis for sure or you can put a central line and replace it every 15 to 20 days. But AV fistula is the best option.


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