Fistula Salvage Procedure

A fistula salvage procedure is performed to rescue and restore the function of an arteriovenous fistula (AVF) that is not functioning optimally for hemodialysis. An AVF is a surgically created connection between an artery and a vein, commonly in the forearm, and is a preferred access for hemodialysis. However, complications such as stenosis (narrowing), thrombosis (clot formation), or other issues can occur, leading to reduced blood flow and inadequate dialysis. Here's an overview of the fistula salvage procedure

Indications for Fistula Salvage

• Fistula Dysfunction: Inadequate blood flow for effective hemodialysis.
• Stenosis or Thrombosis: Narrowing or clot formation within the fistula.

Fistula Salvage Procedure Steps

Evaluation

• Initial assessment involves clinical examination and imaging studies (ultrasound, venography) to identify the site and cause of dysfunction.

Local Anesthesia

• The patient is typically given local anesthesia at the site of the fistula.

Access and Exposure

• The surgeon gains access to the fistula by making a small incision at the site of the dysfunction.

Thrombectomy or Thrombolysis (if applicable)

• If there is a clot (thrombus) present, the surgeon may remove it (thrombectomy) or use medications to dissolve it (thrombolysis).

Angioplasty

• Balloon angioplasty is a common technique used to treat stenosis. A balloon is inflated at the narrowed site to widen the vessel and restore blood flow.

Stent Placement (if needed)

• In some cases, a stent may be placed to help keep the vessel open after angioplasty.

Closure

• The incision is closed, and the patient is monitored for any immediate complications.

Post-Procedure Care

Monitoring

• Regular monitoring of the fistula's function through physical examination and imaging studies.

Anticoagulant Medications

• In some cases, anticoagulant medications may be prescribed to prevent clot formation.

Lifestyle Modifications

• Patients may be advised to make lifestyle modifications, such as avoiding activities that could put stress on the fistula.

Complications

• While the procedure is generally safe, complications may include infection, bleeding, or recurrence of stenosis.