✦ Renal Failure Treatment

AV Fistula (AVF) Creation

Q: How long after AVF creation can I start dialysis?

The AVF requires 6–12 weeks of maturation before the vein is large enough and superficial enough for repeated needle cannulation.

Q: What if the AVF fails to mature?

Failed maturation occurs in 20–30% of cases; balloon angioplasty of stenoses or accessory vein ligation may salvage a failing fistula.

Q: Can an AVF be created in both arms?

AVF creation starts in the non-dominant forearm and progresses up the arm and to the opposite arm if earlier sites fail.

Surgical Creation of Arteriovenous Fistula for Haemodialysis Access

60–90 min PROCEDURE

Day Care HOSPITAL STAY

>80% SUCCESS RATE

6–12 Weeks maturation RECOVERY

What is AV Fistula (AVF) Creation?

AV Fistula (AVF) creation surgically anastomoses an artery to an adjacent vein in the forearm or upper arm, creating a high-flow vascular access channel for haemodialysis. The fistula matures over 6–12 weeks as venous pressure remodels and dilates the vein to a diameter and depth suitable for repeated needle insertion during dialysis sessions. The native AVF is the gold standard haemodialysis access — most durable, lowest infection risk, and longest patency. The procedure is performed under general or spinal anaesthesia with a hospital stay of Day Care.

Patients with chronic kidney disease stage 4–5 or end-stage renal failure planning to start haemodialysis — AVF should be created 3–6 months before dialysis is needed. Patients must be adequately fit for anaesthesia and free from active systemic infection before proceeding.

How the Procedure Works

Imaging Guidance

Pre-operative vascular mapping of forearm and upper arm veins with Doppler ultrasound.

Vessel Selection

Radiocephalic (wrist) or brachiocephalic (elbow) site selected based on vessel calibre.

Incision & Access

Skin incision; artery and vein identified; vessels mobilised and prepared.

Anastomosis

End-to-side or side-to-side anastomosis between artery and vein using 7-0 prolene sutures.

Wound Closure

Thrill confirmed on palpation; wound closed; arm elevated.

Outcomes

60–90 minDURATION

Day CareHOSPITAL STAY

>80%SUCCESS RATE

6–12 Weeks maturationFULL RECOVERY

Who Needs This Treatment?

→Gold standard haemodialysis access — most durable of all options.
→Lowest infection rate of any vascular access type.
→Longest functional patency — median 3–5 years or more.
→No synthetic material used — entirely autologous tissue.
→Avoids risks of tunnelled dialysis catheters — infection and thrombosis.
→Created months before dialysis need — planned, not emergency.

"An AVF is a dialysis patient's lifeline — literally. Creating a mature, functioning fistula months before it is needed gives patients the best possible start on haemodialysis, and the best long-term access outcomes."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

How long after AVF creation can I start dialysis?+

What if the AVF fails to mature?+

Can an AVF be created in both arms?+

Not sure which treatment is right for you?

Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.

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