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AV Fistula Surgery

An arteriovenous (AV) fistula is an irregular connection between an artery and a vein. Usually, blood flows from the arteries to tiny blood vessels (capillaries), and then on to the veins. Nutrients and oxygen in the blood travel from the capillaries to tissues in the body. With an arteriovenous fistula, blood flows directly from an artery into a vein, avoiding some capillaries. When this happens, tissues below the avoided capillaries receive less blood.

Arteriovenous fistulas usually occur in the legs but can develop anywhere in the body. An arteriovenous fistula may be surgically created for use in dialysis in people with severe kidney disease.

Symptoms of arteriovenous fistulas depend on where they form in the body. A large untreated arteriovenous fistula can lead to serious complications. Treatment for arteriovenous fistulas includes monitoring, compression, catheter-based procedures and, sometimes, surgery.

Symptoms

Arteriovenous fistula signs and symptoms may include:

  • Purplish, bulging veins seen through the skin, similar to varicose veins
  • Swelling in the arms or legs
  • Decreased blood pressure
  • Fatigue
  • Heart failure

A significant arteriovenous fistula in the lungs (pulmonary arteriovenous fistula) is a serious condition and can cause:

  • Pale gray or blue lips or fingernails due to lack of blood flow (cyanosis)
  • Fingertips to spread out and become rounder than normal (clubbing)
  • Coughing up blood

An arteriovenous fistula in the digestive tract can cause gastrointestinal (GI) bleeding.

Causes

Arteriovenous fistulas may be present at birth (congenital) or they may occur later in life (acquired). Causes of arteriovenous fistulas include:

  • Injuries that pierce the skin An arteriovenous fistula may result from a gunshot or stab wound that occurs on a part of the body where a vein and artery are side by side.
  • Congenital arteriovenous fistulas In some babies, the arteries and veins don't develop properly in the womb. It's unclear exactly why this happens.
  • Genetic conditionsArteriovenous fistulas in the lungs (pulmonary arteriovenous fistulas) can be caused by a genetic disease that causes irregular blood vessels throughout the body, but especially in the lungs. One such disease is Osler-Weber-Rendu disease, also known as hereditary hemorrhagic telangiectasia
  • Dialysis-related surgeryPeople who have late-stage kidney failure may have a surgery to create an arteriovenous fistula in the forearm to make it easier to perform dialysis.