Fistula
It is the most commonly used and preferred vascular access option for hemodialysis. With a surgical operation performed on the wrist or elbow, a connection (short circuit) is created between the artery and the superficial vein is created. After this operation, during the maturation period (1-3 months), the flow in the vein accelerates and the vein wall thickens and becomes suitable for needle application. Fistulas; ease of creation, With its low risk of problems and ease of use for nurses, it allows a comfortable life for hemodialysis patients for many years.
What is the success of fistula surgery and what are the factors affecting success?
The success of fistula surgery can vary between 70-95%. In case of failure of fistula surgery or insufficient flow, repeated interventions may be required. During the first examination by your vascular surgeon, your vascular structures are evaluated by examination. Then, using Color Doppler Ultrasonography, the diameters and flow characteristics of the arteries and veins in your arm are evaluated. Where and It gives your vascular surgeon an idea about what kind of operation should be performed and the chances of success of the operation.
In fistula operations Three factors affecting success has:
1) Quality of the artery: The artery must be free of lime and flexible enough to expand enough to provide adequate blood flow. For this reason, the chance of success is lower in diabetics, the elderly and those with a history of calcification in their arteries.
2) Quality of the vein: A vein of appropriate width must be present for surgery. Additionally, there should be no blockage in the venous system. In diabetics and women This vascular structure may be less developed. In addition, unnecessary injections and catheter applications in the arm where the fistula is planned disrupt the vascular structure and affect the quality and success of the fistula. In patients with renal failure and hemodialysis patients, both arm veins should be protected. To take blood and give medicine and fluids as much as possible, the hand on the back or veins in the foot should be preferred.
3) Surgical technique and experience: This surgery should be performed by people who are experienced in this field and trained in vascular surgery to eliminate the problems that the surgery may cause. Successful operations performed on the patient's wrist provide years of comfortable use. The patient has the chance to try fistula at most 4-6 times. It is very important to use this opportunity in the most appropriate way. After the patient loses his fistula chances, he needs very difficult and risky operations. For this reason, efforts should be made to have vascular access operations performed by people experienced in this field.
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