The Importance of Immediate Reconstruction of an AV Fistula
Rebuilding an arteriovenous fistula (AVF) promptly is important because it provides patients with a safe, working dialysis access that can be used immediately. This helps reduce the high risks associated with central venous catheters (CVCs).
Avoiding the Risks of Catheters (CVCs)
The main benefit of reconstruction is that it lowers the need for CVCs if a kidney transplant does not work out.
- Preventing Infection:
Currently, nearly two-thirds of patients whose kidney grafts fail must restart hemodialysis (HD) using a CVC, despite clinical efforts to preserve their previous vascular access. CVCs are the least desirable access type due to their high rates of catheter-related bloodstream infections (CRBSI) and life-threatening sepsis. - Immediate Cannulation:
Unlike a newly created AVF, which may take months to mature and often requires multiple interventions, a reconstructed AVF utilizes a previously matured venous conduit. This matured vein can often be cannulated immediately upon reconstruction, allowing the patient to bypass the need for a temporary catheter entirely.
Clinical and Technical Feasibility
Reconstruction is a practical way to support the patient’s long-term Access Succession Plan.
- Sustaining Vascular Real Estate:
By reconstructing an old access rather than creating a new one, surgeons preserve other potential vessels for future use. - Success Rates:
Studies indicate that a significant majority (e.g., 85 out of 112 in one series) of forearm AVFs can be successfully reconstructed even years after they were ligated or allowed to thrombose.
