If you have been diagnosed with kidney failure, or are facing such a diagnosis, then your nephrologist (kidney doctor) has probably mentioned dialysis. Dialysis is the most readily available treatment for kidney failure. It is a process during which a machine does the work of your kidneys, filtering toxins and wastes from your blood, and returning the healthier blood to your body. 

This process will need to be repeated either daily or several times weekly for the rest of your life, depending on the type of dialysis you choose. The two main types of dialysis are hemodialysis and peritoneal dialysis. Hemodialysis is currently the more commonly chosen form. Learn what the surgical preparation for hemodialysis involves.*

Why is surgery necessary before dialysis?

To prepare for dialysis, you need to have a surgical procedure to create an access point for the machine to connect to your body during each dialysis session.

The access point is generally through an artery and a vein, most often in the hand, wrist, or forearm, and the access is provided by a configuration called a fistula. There are several types of fistulas, but according to Kristine Clodfelter Orion, M.D., a vascular surgeon and assistant professor of surgery at Yale School of Medicine, “The longest-lasting and best type of dialysis access is an arteriovenous fistula, or AV fistula.”

AV fistulas are usually preferred because they are reliable and carry a lower risk of infection, clotting, and other complications.

About AV fistulas

An AV fistula for dialysis access is created by stitching together an artery and a vein. This is an outpatient procedure that can be performed under local or general anesthesia. It’s generally done about six months prior to your first dialysis treatment, since healing can take several weeks, and the fistula needs time to mature and grow strong enough to bear up under the strain of the dialysis process. 

The connection of the two blood vessels causes the high-pressure blood flow from the artery to enter the vein, stretching the vein and enlarging it. The increase of vein capacity is necessary for successful hemodialysis sessions.  

Getting an AV fistula

On the day you go to get your fistula, you can expect:

• A physical examination of your arms
• Non-invasive or minimally-invasive tests such as an ultrasound and/or angiogram (to determine the size of your veins and arteries)
• The application of a local anesthetic to numb your arm
• A small incision to be made in your arm by the surgeon, to connect the chosen artery and vein

You should be able to return home in just a few hours following your procedure. Your doctor will likely:

• Give you instructions on access site care
• Instruct you to elevate your arm to minimize pain and swelling
• Prescribe medication for post-operative pain relief

While it can take several weeks or months for your fistula to mature, you will generally be able to return to your normal daily activities soon after your surgery.

How does an AV fistula work during a treatment?

A hemodialysis treatment session begins with a dialysis nurse or tech inserting two needles into the fistula. Blood is removed through one needle and returned through the other after having been filtered of toxins, wastes, and excess fluid by the dialysis machine. Treatments are administered about three times per week, and typically last for three to four hours. 

*Yale Medicine. (2023). Preparing for Dialysis. https://www.yalemedicine.org/conditions/preparing-dialysis-av-fistula#:~