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 Patient Care & Health Information
 Diseases & Conditions

Arteriovenous fistula
 Symptoms & causes
 Diagnosis & treatment
 Doctors & departments

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Overview


Arteriovenous fistula
An arteriovenous (AV) fistula is an abnormal connection between an artery and a vein.
Normally, blood flows from your arteries to your capillaries to your veins. Nutrients and
oxygen in your blood travel from your capillaries to tissues in your body.

With an arteriovenous fistula, blood flows directly from an artery into a vein, bypassing
some capillaries. When this happens, tissues below the bypassed capillaries receive a
diminished blood supply.

Arteriovenous fistulas usually occur in the legs, but can develop anywhere in the body.
Arteriovenous fistulas are often surgically created for use in dialysis in people with
severe kidney disease.

A large untreated arteriovenous fistula can lead to serious complications. Your doctor
monitors your arteriovenous fistula if you have one for dialysis.

Symptoms

Small arteriovenous fistulas in your legs, arms, lungs, kidneys or brain often won't have
any signs or symptoms and usually don't need treatment other than monitoring by your
doctor. Large arteriovenous fistulas may cause signs and symptoms.
Arteriovenous fistula signs and symptoms may include:

 Purplish, bulging veins that you can see through your skin, similar to varicose veins

 Swelling in the arms or legs

 Decreased blood pressure

 Fatigue

 Heart failure

An arteriovenous fistula in your lungs (pulmonary arteriovenous fistula) is a serious

condition and can cause:

 A bluish tinge to the skin

 Clubbing of fingers

 Coughing up blood

An arteriovenous fistula in your gastrointestinal tract can cause bleeding in your

digestive tract.

When to see a doctor

If you have any of these signs and symptoms and think you might have an
arteriovenous fistula, make an appointment to see your doctor. Early detection of an
arteriovenous fistula may make your condition easier to treat and may reduce your risk
of developing complications, such as blood clots or, in severe cases, heart failure.

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Causes

Causes of arteriovenous fistulas include:

 Cardiac catheterization. An arteriovenous fistula may develop as a complication

of a procedure called cardiac catheterization. During cardiac catheterization, a
long, thin tube called a catheter is inserted in an artery or vein in your groin, neck
or arm and threaded through your blood vessels to your heart.
 If the needle used in the catheterization crosses an artery and vein during your
procedure, and the artery is widened (dilated), this can create an arteriovenous
fistula. This rarely happens.

 Injuries that pierce the skin. It's also possible to develop an arteriovenous fistula
after a piercing injury, such as a gunshot or stab wound. This may happen if your
wound is on a part of your body where a vein and artery are side by side.

 Being born with an arteriovenous fistula. Some people are born with an
arteriovenous fistula (congenital). Although the exact reason why isn't clear, in
congenital arteriovenous fistulas the arteries and veins don't develop properly in
the womb.

 Genetic conditions. Arteriovenous fistulas in the lungs (pulmonary arteriovenous

fistulas) can be caused by a genetic disease (Osler-Weber-Rendu disease, also
known as hereditary hemorrhagic telangiectasia) that causes blood vessels to
develop abnormally throughout your body, but especially in the lungs.

 Surgical creation (AV fistula procedure). People who have late-stage kidney
failure may have an arteriovenous fistula surgically created to make it easier to
perform dialysis. If a dialysis needle is inserted into a vein too many times, the vein
may scar and be destroyed.

Creating an arteriovenous fistula widens the vein by connecting it to a nearby

artery, making it easier to insert a needle for dialysis and causing blood to flow
faster. This AV fistula is usually created in the forearm.

Risk factors

Beyond genetic or congenital conditions, your risk of developing an arteriovenous fistula

may increase due to certain factors, including:

 Cardiac catheterization, especially if the procedure involves blood vessels in your

groin

 High blood pressure (hypertension)

 High body mass index (BMI)

  Certain medications, including some blood thinners (anticoagulants) and
medications used to control bleeding (anti-fibrinolytics)

 Older age

 Being female

Complications

Left untreated, an arteriovenous fistula can cause complications, some of which can be
serious. These include:

 Heart failure. This is the most serious complication of large arteriovenous fistulas.
Since your blood flows more quickly through an arteriovenous fistula than it would
if your blood flowed through a normal course of arteries, capillaries and veins, your
heart pumps harder to compensate for the drop in blood pressure (called high-
output heart failure). Over time, the increased intensity of your heart's pumping can
weaken your heart muscle, leading to heart failure.

 Blood clots. An arteriovenous fistula in your legs can cause blood clots to form,
potentially leading to deep vein thrombosis, a painful and potentially life-
threatening condition if the clot travels to your lungs (pulmonary embolism).
Depending on where your fistula is, it can lead to a stroke.

 Leg pain. An arteriovenous fistula in your leg can also cause you to develop pain
in your legs (claudication), or can worsen pain you already have.

 Bleeding. Arteriovenous malformations may lead to bleeding, including into your

gastrointestinal system.

 Risk factors

 Factors that may increase your risk of chronic kidney disease include:

 Diabetes

 High blood pressure

 Heart and blood vessel (cardiovascular) disease

 Smoking

 Obesity
  Being African-American, Native American or Asian-American

 Family history of kidney disease

 Abnormal kidney structure

 Older age

Complications

Chronic kidney disease can affect almost every part of your body. Potential
complications may include:

 Fluid retention, which could lead to swelling in your arms and legs, high blood
pressure, or fluid in your lungs (pulmonary edema)

 A sudden rise in potassium levels in your blood (hyperkalemia), which could impair
your heart's ability to function and may be life-threatening

 Heart and blood vessel (cardiovascular) disease

 Weak bones and an increased risk of bone fractures

 Anemia

 Decreased sex drive, erectile dysfunction or reduced fertility

 Damage to your central nervous system, which can cause difficulty concentrating,
personality changes or seizures

 Decreased immune response, which makes you more vulnerable to infection

 Pericarditis, an inflammation of the saclike membrane that envelops your heart

(pericardium)

 Pregnancy complications that carry risks for the mother and the developing fetus

 Irreversible damage to your kidneys (end-stage kidney disease), eventually

requiring either dialysis or a kidney transplant for survival

Prevention

To reduce your risk of developing kidney disease:

  Follow instructions on over-the-counter medications. When using
nonprescription pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others)
and acetaminophen (Tylenol, others), follow the instructions on the package.
Taking too many pain relievers could lead to kidney damage and generally should
be avoided if you have kidney disease. Ask your doctor whether these drugs are
safe for you.

 Maintain a healthy weight. If you're at a healthy weight, work to maintain it by

being physically active most days of the week. If you need to lose weight, talk with
your doctor about strategies for healthy weight loss. Often this involves increasing
daily physical activity and reducing calories.

 Don't smoke. Cigarette smoking can damage your kidneys and make existing
kidney damage worse. If you're a smoker, talk to your doctor about strategies for
quitting smoking. Support groups, counseling and medications can all help you to
stop.

 Manage your medical conditions with your doctor's help. If you have diseases
or conditions that increase your risk of kidney disease, work with your doctor to
control them. Ask your doctor about tests to look for signs of kidney damage.

For kidney disease diagnosis, you may also need certain tests and procedures, such
as:

 Blood tests. Kidney function tests look for the level of waste products, such as
creatinine and urea, in your blood.

 Urine tests. Analyzing a sample of your urine may reveal abnormalities that point
to chronic kidney failure and help identify the cause of chronic kidney disease.

 Imaging tests. Your doctor may use ultrasound to assess your kidneys' structure
and size. Other imaging tests may be used in some cases.

 Removing a sample of kidney tissue for testing. Your doctor may recommend a
kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done
with local anesthesia using a long, thin needle that's inserted through your skin and
into your kidney. The biopsy sample is sent to a lab for testing to help determin

ecommend that you:


  Lifestyle and home remedies

 As part of your treatment for chronic kidney disease, your doctor may
recommend a special diet to help support your kidneys and limit the work they
must do. Ask your doctor for a referral to a dietitian who can analyze your current
diet and suggest ways to make your diet easier on your kidneys.

 Depending on your situation, kidney function and overall health, your dietitian
may recommend that you:

Avoid products with added salt. Lower the amount of sodium you eat each day
by avoiding products with added salt, including many convenience foods, such as
frozen dinners, canned soups and fast foods. Other foods with added salt include
salty snack foods, canned vegetables, and processed meats and cheeses.

 Choose lower potassium foods. Your dietitian may recommend that you choose
lower potassium foods at each meal. High-potassium foods include bananas,
oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods
include apples, cabbage, carrots, green beans, grapes and strawberries. Be aware
that many salt substitutes contain potassium, so you generally should avoid them if
you have kidney failure.

 Limit the amount of protein you eat. Your dietitian will estimate the appropriate
number of grams of protein you need each day and make recommendations based
on that amount. High-protein foods include lean meats, eggs, milk, cheese and
beans. Low-protein foods include vegetables, fruits, breads and cereals.