AV fistula creation is a type of vascular access surgery that may be performed for a patient who needs or is preparing for hemodialysis. During the procedure, a vascular surgeon will connect an artery directly to a vein, usually in an arm, to create a durable access point that can be used to move blood between the patient and the dialysis machine.
Tampa General Hospital (TGH) offers AV fistula surgery and a comprehensive range of vascular surgery services to patients throughout Brooksville, Spring Hill, Crystal River and surrounding communities. AV fistula creation procedures are performed at TGH Brooksville, with vascular care available to patients across the region.
What Is an AV Fistula?
An AV fistula is a surgically created connection between an artery and a vein. Normally, arteries carry blood away from the heart and veins return blood to the heart, with the blood passing through a network of much smaller vessels between them. Creating a direct connection between an artery and a vein allows the stronger blood flow from the artery to enter the vein. Over time, this increased blood flow can cause the vein to enlarge and its walls to become thicker and stronger, helping it withstand the repeated needle placement and blood flow required for hemodialysis.
Because an AV fistula will need time to develop before it can reliably support hemodialysis, dialysis fistula creation is often planned before treatment is expected to begin. Not every fistula matures adequately, however, and the vascular and dialysis teams will monitor the access to determine if and when it is ready for use.
Why Is an AV Fistula Used for Hemodialysis?
Hemodialysis removes waste products and excess fluid from the blood when the kidneys can no longer perform these functions adequately. During each treatment, blood travels from the body to a dialysis machine, where it is filtered, and then returns to the bloodstream. This process requires vascular access that can provide the blood flow needed for effective dialysis.
Once an AV fistula has matured, two needles can be placed into the enlarged vein during each dialysis session. One needle will carry blood to the dialysis machine, and the other will return the filtered blood to the body. Because a well-functioning fistula can withstand repeated use, it can provide reliable long-term access for a patient receiving ongoing hemodialysis.
How Does an AV Fistula Compare With an AV Graft or Dialysis Catheter?
An AV fistula, an AV graft and a dialysis catheter can all provide access to the bloodstream for hemodialysis. However, each option creates that access differently:
- AV fistula – A vascular surgeon will connect one of the patient’s own arteries directly to a vein. When the fistula is feasible and matures successfully, it will generally last longer and have a lower risk of infection and clotting compared with other types of hemodialysis access.
- AV graft – A surgeon will use a synthetic tube to connect an artery and vein. A graft may be appropriate if the patient’s blood vessels are not suitable for fistula creation or if other considerations make a graft a better access option. It generally can be used sooner than a fistula but may be more prone to infection and clotting.
- Dialysis catheter – A clinician will insert a flexible tube into a large vein, usually in the neck. The catheter can be used immediately, making it an important option when hemodialysis must begin before a fistula or graft is ready. However, it generally carries a higher risk of infection and other complications and is therefore most commonly used for temporary access.
An AV fistula is often preferred for long-term hemodialysis access when it is appropriate for the patient, but it is not automatically the best choice in every situation. The dialysis access plan should account for the patient’s blood vessels, anticipated dialysis needs and broader treatment plan.
When Is AV Fistula Creation Recommended?
AV fistula creation may be recommended for a patient with advanced chronic kidney disease who is expected to need hemodialysis or for a patient who is already receiving hemodialysis and needs a more suitable form of long-term vascular access.
An AV fistula is not appropriate for every patient. The vascular surgeon will work closely with the patient’s nephrology and dialysis teams to determine whether a fistula fits the overall treatment plan and whether suitable blood vessels are available for its creation. In some cases, an AV graft, dialysis catheter or another access strategy may be more appropriate.
Why Is Planning for Dialysis Access Important?
Planning vascular access is essential to provide time to create an AV fistula and allow it to mature before hemodialysis is needed. During maturation, increased blood flow through the newly connected vein can help it become larger and stronger so it can eventually accommodate the needles and blood flow required during dialysis.
If hemodialysis must begin before a fistula is ready for use, a different form of vascular access, such as a dialysis catheter, may be needed temporarily. Coordinating care among the nephrology, vascular surgery and dialysis teams can help ensure that an appropriate access option is available when treatment is needed.
How Is the Location of an AV Fistula Selected?
Before arteriovenous fistula surgery, the vascular surgeon will evaluate the arteries and veins to determine where a fistula can be created. This assessment commonly includes vein mapping, an ultrasound examination that provides information about the size, location and condition of blood vessels in the arms.
When possible, the fistula will be created in an arm, and the surgeon will select a location that can provide suitable blood flow and reliable access for dialysis. Depending on the patient’s blood vessels, options may include connecting an artery and vein near the wrist or elbow. In some cases, a deeper vein may need to be repositioned closer to the skin so it can be accessed more easily during dialysis.
Careful access planning also considers the need to preserve blood vessels that may be useful for dialysis in the future. The selected approach is intended to provide dependable hemodialysis access while maintaining additional vascular access options whenever possible.
What to Expect During AV Fistula Surgery
During AV fistula surgery, the vascular surgeon will create a direct connection between an artery and a vein, typically in an arm. The procedure may be performed using local or regional anesthesia, sometimes with sedation, or another type of anesthesia based on the planned procedure and the patient’s needs.
The surgeon will make an incision near the selected blood vessels and connect the vein to the artery, redirecting some of the higher-flow arterial blood directly into the vein. After creating the fistula, the surgeon will check blood flow through the new connection. A vibration known as a thrill can often be felt beneath the skin over the fistula, indicating that blood is flowing through the access. The incision will then be closed and covered with a dressing.
AV fistula creation is often performed as an outpatient procedure, although the length of the stay can vary. Before the patient leaves the surgical center, the care team will provide instructions for protecting the access arm, caring for the surgical site and monitoring the fistula as it heals and begins to mature.
How Long Does an AV Fistula Take to Mature?
An AV fistula cannot usually be used for hemodialysis immediately after it is created. Instead, it will need time to mature, meaning the vein must become large and strong enough to support the blood flow and repeated needle placement required for dialysis. This process commonly takes several weeks to a few months, although the specific maturation time can vary from patient to patient.
During the maturation period, the healthcare team will monitor the fistula to determine how well it is developing. The patient may be instructed to regularly feel for the thrill, or vibration, over the fistula and report if it becomes weaker or can no longer be felt. Follow-up examinations and, when needed, ultrasound or other testing can help determine whether the fistula is developing adequate blood flow and is ready for dialysis.
A fistula should not be used simply because a certain amount of time has passed. Before dialysis begins through the access, the healthcare team will determine whether the fistula has matured sufficiently for safe and reliable needle placement.
What Happens if an AV Fistula Does Not Mature?
Not every AV fistula develops well enough to be used for hemodialysis. A fistula may have difficulty maturing if blood flow through the access is inadequate or if narrowing or another vascular issue prevents the vein from enlarging as expected.
If a fistula is not maturing properly, the vascular team may perform additional testing to identify the cause. In some cases, an endovascular or surgical procedure can improve blood flow or address another problem that is interfering with maturation. If the fistula cannot be made suitable for dialysis, another fistula, an AV graft or a different form of vascular access may be necessary.
Monitoring the fistula during maturation can help the healthcare team identify problems early and determine whether intervention or an alternative dialysis access plan is needed.
What Is Recovery Like After AV Fistula Creation?
Recovery after AV fistula surgery is generally focused on allowing the incision to heal while protecting the newly created vascular access. Some soreness, bruising or swelling around the surgical area can be expected during the initial recovery period. The healthcare team will provide instructions about incision care, activity restrictions and when normal activities can be resumed.
Although the surgical site may heal before the fistula is ready for dialysis, the access will continue to mature beneath the skin. Follow-up appointments will allow the vascular team to evaluate healing, check blood flow through the fistula and monitor its development.
How Should an AV Fistula Be Cared for After Surgery?
Protecting the fistula is important both during maturation and after it begins being used for dialysis. The patient should follow the specific instructions provided by the vascular and dialysis teams.
Care recommendations may include:
- Checking the fistula regularly – The patient may be instructed to feel for the thrill, or vibration, over the fistula each day. A thrill that becomes noticeably weaker or disappears can indicate a problem with blood flow and should be reported promptly.
- Protecting the access arm – Blood pressure measurements, blood draws and IV placement generally should be avoided in the fistula arm. The patient also should avoid prolonged pressure or tight clothing or jewelry over the access.
- Keeping the surgical site clean and dry – Incision care instructions should be followed while the area heals.
- Watching for signs of infection or other problems – Increasing redness, warmth, swelling, drainage or pain around the surgical site should be reported. The care team should also be contacted about persistent or significant bleeding.
- Following activity instructions – The vascular team will explain when the patient can resume lifting, exercise and other activities involving the access arm.
The patient should also seek prompt medical guidance for concerning changes in the hand or arm, such as new or worsening coldness, numbness, weakness, discoloration or significant pain. These symptoms can indicate that blood flow to the hand has been affected and should be evaluated.
What Are the Risks of AV Fistula Creation?
AV fistula creation is a commonly performed form of vascular access surgery, but complications can occur during healing, maturation or long-term use. Possible risks include:
- Failure to mature – Some fistulas do not develop enough blood flow or become large and strong enough to support hemodialysis. Additional treatment or another form of vascular access may be needed.
- Narrowing or clotting – The blood vessels that form the AV fistula can develop narrowing, known as stenosis, which can reduce blood flow through the access. A blood clot may also form and partially or completely block the fistula.
- Infection – AV fistulas generally have a lower risk of infection than AV grafts and dialysis catheters, but infection can still develop at the surgical or needle insertion sites.
- Bleeding – Bleeding can occur after surgery or from the needle insertion sites once the fistula is being used for dialysis.
- Reduced blood flow to the hand – In some patients, the fistula diverts enough blood through the access that circulation to the hand becomes inadequate. This complication, sometimes called dialysis access steal syndrome, can cause symptoms such as hand pain, coldness, numbness or weakness, which may require treatment.
- Changes in the fistula over time – Repeated use and changes in blood flow can cause portions of the fistula to enlarge or weaken, sometimes resulting in an aneurysm. These areas may require monitoring or treatment.
Regular examination of the fistula by the patient and healthcare team can help identify changes in the access before they interfere with dialysis. If a fistula develops a problem, treatment may be able to restore or preserve its function. In other cases, a new fistula, AV graft or another access option may eventually be necessary.
Consult With Our Vascular Surgery Services Team
Planning reliable vascular access is an important part of preparing for hemodialysis. At Tampa General Hospital, our vascular surgeons work with nephrology and dialysis teams to plan and create AV fistulas to support each patient’s long-term dialysis access needs. Through ongoing evaluation, we can also identify and address problems that may affect fistula maturation or long-term function.
TGH offers comprehensive vascular surgery services to patients throughout Brooksville, Spring Hill, Crystal River and surrounding communities. AV fistula creation procedures are performed at TGH Brooksville, helping patients across the region access specialized vascular care as they prepare for or continue hemodialysis.
Tampa General is ranked No. 1 in the Tampa Bay region for Cardiology, Heart & Vascular Surgery by U.S. News & World Report for 2026-27. To learn more about AV fistula creation or other hemodialysis access options, contact TGH to schedule an appointment with our vascular surgery services team.