AV Fistula Creation

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maximum cost

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Things you need to know

What is AV Fistula Creation ?

Why do you need AV Fistula Creation ?

AV fistula creation is indicated for:

End-stage renal disease (ESRD):
- Patients requiring hemodialysis (HD); AV fistula is the gold standard access (60–70% of HD patients in India).
- Prevalence in India: 150–200 per million population on dialysis (2023 data); 10–15% annual increase in ESRD cases.
Other indications:
- Pre-dialysis patients with worsening kidney function (eGFR <15 mL/min/1.73 m²) to prepare for HD.
- Failed AV grafts or catheters (higher infection rates; catheters used in 20–30% of patients initially).
Types:
- Radiocephalic fistula: Most common (wrist; radial artery to cephalic vein; 50–60% of cases).
- Brachiocephalic fistula: Upper arm (brachial artery to cephalic vein; 20–30%).
- Brachiobasilic fistula: Upper arm with basilic vein transposition (less common; 10–15%).
Associated treatments:
- Pre-op: Vein mapping (ultrasound) to assess vessel suitability (vein diameter >2.5 mm, artery >2 mm).
- Post-op: Fistula maturation (4–8 weeks); “rule of 6s” for readiness (6 mm diameter, <6 mm depth, flow >600 mL/min).
Timing:
- Performed in adults (average age 40–70 years for ESRD); ideally 3–6 months before dialysis starts.

The procedure aims to provide a reliable, long-term access for hemodialysis, reducing infection risks and improving dialysis efficiency, with a high success rate for maturation and functionality.

Why Do AV Fistula Creation Costs Vary in Philippines?

AV Fistula Creation Procedure

BeforeSurgery Evaluation:
- Assessment:
  - Ultrasound: Vein mapping to assess vessel size, patency, and depth (e.g., cephalic vein >2.5 mm ideal).
  - Blood tests: Blood sugar (diabetes control), clotting profile; kidney function (creatinine, eGFR).
  - Physical exam: Check pulses, Allen test (for radial artery patency).
- Preparation: Avoid venipuncture in target arm; stop blood thinners (if safe); fasting 4–6 hours.
- Consent: Risks, including failure to mature, are explained.
Surgical Technique:
- AV Fistula Creation (Radiocephalic):
  - Performed under local anesthesia (with sedation if needed), lasting 1–2 hours.
  - Process:
    - Incision: 2–4 cm at wrist (radiocephalic) or upper arm (brachiocephalic).
    - Radial artery and cephalic vein isolated; small branches ligated to prevent flow diversion.
    - Anastomosis: Artery and vein connected (end-to-side or side-to-side; 5–7 mm opening) with fine sutures (e.g., 6-0 polypropylene).
    - “Thrill” confirmed: Palpable vibration indicating good flow; Doppler used intra-op.
    - Closure: Sutures in layers; absorbable sutures for skin; no drain typically needed.
  - Alternative Approaches:
    - Brachiobasilic: Requires vein transposition (additional incision, two-stage procedure if needed).
    - Endovascular fistula: Newer, less common; uses catheter-based techniques (e.g., Ellipsys system).
- Intraoperative Tools:
  - Doppler probe: Confirms flow and thrill.
  - Microsurgical instruments: For precise anastomosis.
  - Heparinized saline: Prevents clotting during surgery.
After Surgery:
- Hospital stay: Same-day discharge or 1 day.
- Care: Keep arm elevated to reduce swelling; avoid pressure on fistula (no tight clothing, no blood pressure cuffs).
- Pain management: Mild pain for 1–3 days; managed with painkillers (e.g., paracetamol).
- Instructions: Hand exercises (e.g., squeezing ball) to promote flow; monitor for thrill daily; avoid heavy lifting for 4–6 weeks.

Recovery After AV Fistula Creation

Hospital Stay: Same-day discharge or 1 day.
Post-Surgery Care:
- Pain/Swelling: Mild pain for 1–3 days; swelling resolves in 1–2 weeks.
- Activity: Avoid strenuous activity with the arm for 4–6 weeks; light activities in 1–2 days.
- Incision: Small scar (2–4 cm) fades in 3–6 months.
- Fistula maturation: 4–8 weeks; monitor thrill/bruit (audible whooshing); ultrasound at 4–6 weeks to confirm readiness.
- Dialysis use: Starts at 6–8 weeks if mature; temporary catheter if urgent dialysis needed.
Follow-Up:
- Visits at 1 week (check healing), 4–6 weeks (assess maturation), and as needed before dialysis.
- Ultrasound: At 4–6 weeks to confirm “rule of 6s”; 70–80% mature successfully by 8 weeks.

Most resume normal activities in 1–2 weeks; full fistula maturation takes 4–8 weeks. Success rate: 70–80% mature for dialysis; 90% patency at 1 year if matured; 60–70% at 5 years.

Risks and Complications

Surgical Risks:
- Bleeding (1–3%): Hematoma at site; may resolve or need drainage.
- Infection (1–3%): At incision site; treated with antibiotics; rare but serious if fistula infected.
- Anesthesia risks (<1%): Reaction to local anesthesia; minimal risk.
Post-Surgery:
- Failure to mature (20–30%): Inadequate flow or vein dilation; may need revision or new fistula.
- Thrombosis (5–10%): Clot in fistula; may need thrombectomy or new access.
- Steal syndrome (1–5%): Reduced hand blood flow; may need ligation or distal revascularization.
- Swelling (5–10%): Arm edema; usually temporary, managed with elevation.
Long-Term:
- Aneurysm (2–5%): Fistula dilation over years; may need repair.
- Stenosis (10–20%): Narrowing; may need angioplasty (as in your prior query).

Report loss of thrill, fever, severe swelling, or cold/painful hand promptly.

Frequently Asked Questions (FAQs)

What causes the need for AV fistula creation?

End-stage renal disease (ESRD) requiring hemodialysis; preferred access to reduce infection risks.

Can I avoid AV fistula creation?

Yes, temporarily: Catheters or AV grafts; fistula preferred for long-term dialysis (lower infection rate, 2–3 times less than catheters).

Is AV fistula creation painful?

Mild pain for 1–3 days, managed with medication; resolves in 1–2 weeks.

How soon can I resume normal activities?

Light activities: 1–2 days; full recovery: 4–6 weeks; avoid strenuous arm activity for 4–6 weeks.

Is AV fistula creation covered by insurance in India?

Often covered (medical necessity); confirm with your provider; Ayushman Bharat often subsidizes.

Signs of complications?

Loss of thrill, fever, severe swelling, or cold/painful hand.

How long does an AV fistula last?

90% functional at 1 year if matured; 60–70% at 5 years; may need revisions.

Lifestyle changes post-surgery?

Protect fistula arm (no pressure, IVs, or blood draws), perform hand exercises, monitor thrill, and attend follow-ups.

Conclusion

Looking for Best Hospitals for AV Fistula Creation

Note: we are not promoting any hospitals

We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)

click on your city and schedule your surgery now done in good hands.

City	Minimum Price (₱)	Maximum Price (₱)
Angeles City	30,000	100,000
Antipolo	30,000	100,000
Bacolod	30,000	100,000
Bacoor	30,000	80,000
Baguio	30,000	100,000
Butuan	30,000	80,000
Cagayan de Oro	30,000	100,000
Caloocan	30,000	80,000
Cebu City	40,000	150,000
Dasmariñas	30,000	80,000
Davao City	40,000	150,000
General Santos	30,000	100,000
General Trias	30,000	80,000
Iligan	30,000	100,000
Iloilo City	30,000	100,000
Las Piñas	30,000	100,000
Makati	40,000	150,000
Malolos	30,000	80,000
Manila	40,000	150,000
Muntinlupa	30,000	100,000
Parañaque	30,000	100,000
Pasay	30,000	100,000
Pasig	40,000	150,000
Puerto Princesa	30,000	100,000
Quezon City	40,000	150,000
San Fernando	30,000	80,000
San Jose del Monte	30,000	80,000
Taguig	40,000	150,000
Valenzuela	30,000	80,000
Zamboanga City	30,000	100,000

Disclaimer

This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.