An arteriovenous fistula is the gold standard among all types of accesses for hemodialysis. It basically involves ‘joining’ an artery and a vein so that the vein is capable of carrying blood at pressures high enough to allow dialysis.

The whole trouble with fistulas is that there are a limited number of sites in the body where they can be made. Once a site is used or even attempted to be used, it can no longer be used again! That is why, it is so important to preserve sites for fistulas very, very carefully.

Unfortunately, many doctors today don’t treat this with the importance it deserves. There are some simple things that can be done to ensure that we preserve sites for fistulas well. For example, before selecting a site, check all available options and if necessary, do a scan to check the size of the veins. Many fistula surgeries have failed because of insufficient size of the veins.

Once a fistula is made and a problem is discovered, all attempts must be made to rectify the problem rather than hurry into a new fistula! The site is precious. Only after all attempts at restoring the current fistula have failed should a new fistula be attempted.

Talk to your nephrologist about the vascular surgeons he or she would recommend and convince yourself that he or she is good. Talk to the surgeon as well. Get a sense of his comfort-level in creating the fistula. Check if he thinks the size of the veins is good enough. Read up all you can on fistulas.

Remember, the more involved you are in your health, the better it is for you.