At North Orlando Surgical Group, we are proud to have established a unique surgical practice characterized by superior skills and extraordinary services both to the patient we care for as well as their referring physicians. We are recognized in Central Florida for our ability to perform complex procedures in the least invasive way. Our attentive staff is focused on providing the highest level of personal services and are committed to making every patient’s surgical experience as comfortable and convenient as it can be.
There are two types of vascular access designed for long-term use to include the arteriovenous (AV) fistula and the AV graft. A third type of vascular access is a venous catheter which is used for short term dialysis due to increased risk of infection. The access is a surgically created vein used to remove and return blood during dialysis. A vascular access allows a large amount of blood to flow through the machine and then be returned to your body once filtered.
• AV Fistula
An AV fistula is a connection between an artery and a vein usually placed in your arm. An AV fistula causes extra pressure and blood to flow through the vein allowing the vein to mature, grow large and strong. Having a larger vein provides easier access to the blood vessels for dialysis. Our surgeons recommend AV fistula as it provides better blood flow for dialysis, usually lasts longer than other access types, and is less likely to get infected as it is part of your own body. Before recommending AV fistula surgery, our surgeons may send you for a vessel mapping via ultrasound to evaluate the veins in your arms to determine which one is best for surgery.
Your surgery can be performed either at an outpatient surgery center or done at the hospital as an outpatient meaning you can go home the same day. A local anesthesia is applied to area to numb the area where your surgeon will create the fistula. Once discharged home you will be encouraged to exercise the fistula by squeezing a ball to help mature “plump up” the vein. You will usually follow up in the office four weeks after surgery for evaluation. Your surgeon will determine when your fistula is ready to be accessed by the dialysis center so recommended follow up is crucial.
• AV Graft
An AV graft is a plastic tube that connects an artery to a vein. As with AV fistula surgery, this surgery can be performed as an outpatient procedure. An AV graft can usually be used 3-4 weeks after surgery. Unfortunately an AV graft is more likely than an AV fistula to have problems with infection and clotting.
• Venous Catheters
A venous catheter is a tube which is inserted into a vein in the neck, chest, or leg near the groin. This catheter is usually only for a short period of time. Venous catheters are not ideal for long term use due to increased risk of infection and vein narrowing. If a patient needs to start dialysis right away and is unable to wait for placement of an AV fistula or graft then a venous catheter may be the best course of treatment to begin dialysis treatments. There is no showering while venous catheter is in place.
Once home from surgery to create your permanent access you should keep the incision clean and dry. To decrease the amount of swelling you develop post operatively we recommend elevating your arm on a pillow to keep the swelling at a minimum. You will also be asked to exercise the hand by squeezing a soft ball. This encourages the fistula to grow and mature. It can take between 6 week and three months for it to mature enough to be used.
Choosing the right type of dialysis access for you is important to ensure the success of your treatment. Our surgeons are expert at these procedures and perform a high volume of them. Call us today for a consultation.