01
Radiocephalic AV Fistula (Wrist)
Gold StandardFirst-choice fistula. The radial artery at the wrist is connected to the cephalic vein. Preserves higher veins for future access if needed. Lowest complication rate.
Vascular Access for Haemodialysis
DIALYSIS AV FISTULASURGERY
Professor Dr. S.M.G. Kibria
Radiocephalic · Brachiocephalic · AV Graft · Day case
- FRCS (England)
- FRCS (Glasgow)
- FRCS (Edinburgh)
- FRCS (General)
- MSc (Leeds)
- MBBS (DMC)
The Procedure
What Is AV Fistula Surgery?
The gold standard for long-term dialysis access — a surgical connection between an artery and a vein that transforms the vein into a robust, needle-able channel.
Vascular Access
A long-lasting lifeline for haemodialysis
When kidneys fail, haemodialysis takes over their work — and reliable vascular access is essential. An arteriovenous fistula (AVF) connects an artery to a vein in the arm, so arterial pressure thickens the vein wall over 6–12 weeks. The result is a durable, high-flow channel that can be needled three times a week for years — the gold standard for dialysis access worldwide.
- 60–90 minsDay-case procedure
- LocalAwake anaesthesia
- Same dayHospital discharge
- 10+ yearsTypical lifespan
Who Needs One
When You Need an AV Fistula
Early fistula creation, before dialysis becomes urgent, gives the best long-term outcomes. The following warrant referral to a vascular surgeon.
- eGFR < 20 mL/min — approaching end-stage renal disease, dialysis on the horizon.
- Established dialysis on a catheter — central lines should be replaced with a fistula as soon as possible.
- Failed previous fistula — second-line site selection guided by vein mapping.
- Maturation problems — existing fistula that hasn't matured may need balloon dilatation or revision.
- Steal syndrome — hand pain or numbness due to flow diverted away — needs revision.
- Aneurysmal fistula — bulging or pulsating swelling along the fistula needs assessment.
- Inadequate veins for fistula — AV graft may be the right alternative.
- Pre-transplant planning — temporary access while awaiting kidney transplant.
Surgical Options
Types of Dialysis Access Surgery
Prof. Kibria selects the optimal site and technique based on pre-operative vein mapping, age, vessel quality, and prior access history.
02
Brachiocephalic AV Fistula (Elbow)
High FlowBrachial artery at the elbow connected to the cephalic vein. Higher flow, easier maturation — chosen when wrist veins are unsuitable. Used for many female and elderly patients.
03
Brachiobasilic Fistula with Transposition
Salvage OptionFor patients without suitable cephalic veins. The deeper basilic vein is mobilised and brought superficially to make it cannulable. Two-stage operation, but excellent durability.
04
AV Graft (Synthetic)
When Veins UnsuitableA synthetic PTFE tube connects the artery and vein. Matures in 2–3 weeks (much faster than fistula), but shorter lifespan and more interventions needed. Used when native vein options are exhausted.
After Surgery
Maturation & Care Timeline
Fistula creation is just the start — successful maturation takes 6–12 weeks of patience and self-care.
Day 0 — Operation Day
Day-Case Surgery
60–90 minute procedure under local or regional anaesthesia. Arm comfortable, light dressing applied. Discharged home the same day with clear instructions and pain relief.
Week 1 — Wound Review
Sutures Removed
Wound review and sutures removed. Begin fistula exercises (squeezing a soft ball or rubber object) 20–30 times, several times daily, to encourage maturation.
Weeks 2–6 — Maturation
Vein Thickens & Enlarges
The vein develops a strong thrill (buzzing) and bruit (whooshing sound). Daily exercises. Avoid blood pressure cuffs or blood draws from that arm. Keep arm clean.
6–12 Weeks — Maturity
First Cannulation
Ultrasound or duplex confirms maturity: flow > 600 mL/min, diameter > 6mm, depth < 6mm. First needling for dialysis under expert nursing care. Initially smaller needles.
Long-Term — Surveillance
Lifelong Care
Regular surveillance ultrasound, careful cannulation rotation, protect from injury, periodic balloon angioplasty for narrowings. A well-cared-for fistula can last more than a decade.
What is an AV fistula?
A surgical connection between an artery and a vein in the arm. High-flow blood thickens the vein wall over 6–12 weeks so it can be needled reliably for haemodialysis. The gold-standard, longest-lasting dialysis access.
How long does it take for a fistula to mature?
6–12 weeks typically. Fistula exercises (squeezing a ball) help. Some fistulas mature in 4 weeks; others need balloon dilatation.
Is AV fistula surgery painful?
No. Performed under local or regional anaesthesia — you're awake but feel nothing in the arm. Mild discomfort for a day or two afterwards.
How long does an AV fistula last?
10+ years with proper care. Long-term patency depends on careful needling, avoiding compression, and periodic surveillance.
AV fistula vs AV graft — what's the difference?
Fistula uses your own artery and vein — longer-lasting, fewer infections, gold standard. Graft uses synthetic tubing — faster to mature (2–3 weeks) but shorter lifespan. Choice depends on vein quality.
When should I have my fistula created?
Ideally 3–6 months before you need dialysis — once eGFR drops to around 20. Early creation allows maturation before dialysis is urgent.
What care does my fistula need?
Daily exercises, no blood pressure on that arm, no tight clothing, no heavy lifting, feel for the thrill daily, report any change immediately.
Where is AV fistula surgery performed in Dhaka?
Lake View Clinic — House-05, Road 79, Gulshan-2. SMG Kibria Foundation — Ta-97, Middle Badda, Gulshan. Call +880 1711-402445.
Take the First Step
World-Class Surgical Care, Right Here in Dhaka
Whether you need a surgical consultation, a second opinion, or emergency care — Professor Dr. SMG Kibria and his team are here for you.