Dialysis Access at CritiCare Asia Hospitals, Kurla
People with kidney failure who need haemodialysis must have a safe route for blood to be taken out, filtered and returned to the body, often several times a week. That route is called dialysis access. CritiCare Asia Hospitals is a vascular surgery hospital in Mumbai where the vascular team works with the nephrology team to plan and create access suited to each patient's blood vessels and treatment timeline. Access should not be a last-minute step, because a fistula needs time to mature before it can be used safely. AV fistula treatment in Kurla, Mumbai is therefore best planned well before kidney function falls to the point where dialysis begins.
Signs That Call for Attention
Some signs mean it is time to plan access. Others mean an existing fistula needs a check.
- Kidney function falling steadily, with the nephrologist expecting dialysis in the future
- Swelling, tiredness or poor appetite linked to advancing kidney disease
- Loss of the "thrill", the gentle buzzing felt over a healthy fistula
- Redness, warmth, pain or discharge at the access site
- Swelling of the arm, or a bulge along the fistula
- Difficulty during dialysis, such as poor flow or repeated needle problems
A fistula that suddenly goes quiet or hard, or an infected site, needs same-day attention.
Understanding AV Fistulas
An arteriovenous (AV) fistula is a connection made by surgery between an artery and a vein, usually in the arm. Blood from the artery makes the vein wider and stronger over time. This is called maturation and usually takes several weeks to months. Once matured, the fistula can take repeated needle insertions over years of dialysis.
Where the veins allow, a fistula is usually the first choice, since it has lower rates of infection and clotting than other types of access, such as grafts (artificial tubes) or catheters (thin tubes placed in a large vein). Not every patient is suitable. The vascular team considers:
- Vein size and quality, since veins need enough width and healthy walls
- Artery condition, as good blood inflow is needed for maturation
- Overall blood vessel health, which diabetes and peripheral vascular disease can affect
- Arm dominance and daily routine, with the non-dominant arm chosen where possible to cause less disruption
The AV fistula specialists in Kurla assess all of these before planning.
Planning and Creation of an AV Fistula
Before AV fistula surgery in Kurla, the team maps the arteries and veins with ultrasound, which shows a suitable site and whether a fistula is possible at all. The procedure is usually done under local anaesthesia, and the surgeon joins the chosen artery and vein directly. Afterwards, the fistula is monitored to see that it matures properly, and the site needs care to prevent infection and clotting. Patients are shown how to check the fistula at home by feeling for the thrill.
Complications and Monitoring
AV fistulas need continuing monitoring. Possible problems include:
- Failure to mature, where the vein never widens or strengthens enough for dialysis needles
- Stenosis, a narrowing at or near the join that cuts blood flow
- Thrombosis, a clot that blocks the fistula and stops it working
- Infection at the access site, which needs prompt treatment
- Aneurysm, a local bulge in the vein wall from repeated needling
Regular check-ups let the team find and treat these early, which helps keep the fistula working for as long as possible and reduces repeat procedures.
Treatment Options for Dialysis Access
An AV fistula is the usual first option. Where veins are not suitable, a graft or a catheter may be used, and the team explains the trade-offs. When a problem is found in an existing fistula, treatment depends on the cause. Angioplasty, in which a small balloon opens a narrowed segment, or revision surgery may be considered. Clots and infection need prompt treatment to protect the access.
Dialysis Access at CritiCare Asia Hospitals, Kurla
At CritiCare Asia Hospitals, the vascular surgery team coordinates with nephrology colleagues to plan a fistula well before it is expected to be needed, since timely planning improves the chance of a fistula that works for a long time. The team supports patients through maturation and ongoing monitoring, and deals promptly with complications so dialysis schedules are disturbed as little as possible. Book a consultation with the vascular surgery team at CritiCare Asia Hospitals, Kurla, if you or a family member needs dialysis access planning.