Arterial Venous Fistula
An Arterial Venous Fistula (AVF) is a surgically created connection between an artery and a vein, designed to provide reliable vascular access for patients undergoing dialysis.
This procedure is widely considered the gold standard for dialysis access because it ensures high blood flow, which is essential for effective treatment.
By allowing the vein to handle the repeated needle insertions required during dialysis, an AVF also reduces the risk of complications like infection or clotting.
As Dr AVC’s Director Vascular Surgeon Dr Jason Toniolo puts it, “An AVF is not just a surgical procedure; it’s a lifeline that improves both the effectiveness of dialysis and the quality of life for patients.”
Fact: Research shows that AVFs reduce infection significantly compared to catheters – and offer superior longevity, often lasting years with proper care.*1
Dialysis requires vascular access to filter blood effectively.
The three main types are:
- Arterial Venous Fistula (AVF): The most durable and reliable option.
- Arterial Venous Graft (AVG): Uses a synthetic tube to connect an artery and a vein, suitable for patients with weak veins.
- Central Venous Catheter: A temporary solution often used in emergency settings but carries higher risks of infection.
Outcomes Comparison

Did You Know? Studies have shown that AVFs have superior clinical outcomes compared to CVCs, including lower infection rates and improved long-term patency. *2
An AVF is typically recommended for patients with chronic kidney disease (CKD) or end-stage renal failure who need regular dialysis.
Early planning for AVF surgery is crucial, especially for patients with:
- Healthy veins and arteries, as they allow for a more successful procedure.
- A history of requiring dialysis, ensuring a smoother transition to treatment.
The process of creating an AVF involves three key steps:
- Preoperative Planning: Using tools like Doppler ultrasound, the surgeon evaluates veins and arteries to determine the best site for the fistula.
- Surgical Procedure: The surgeon connects an artery and a vein, usually in the forearm or upper arm, to create a high-flow circuit.
- Recovery and maturation: The fistula strengthens over 4–8 weeks, preparing it for the demands of dialysis.
Local care: AVF creation is offered at Gregory Hills, Wollongong, and Orange, with bulk-billed imaging available to make care more accessible.*3
An AVF offers numerous advantages over other dialysis access types:
- Durability: An AVF can last for years, reducing the need for repeated surgeries.
- Improved dialysis efficiency: The high blood flow ensures toxins and waste are removed effectively during treatment.
- Lower risk of infection: Compared to catheters, AVFs significantly reduce the likelihood of infections.
- Enhanced quality of life: A properly functioning AVF ensures fewer interruptions in dialysis schedules.
Clinical Benefits of AVFs Over Catheters
Benefit | AVF | Catheter |
---|---|---|
Infection Risk | 40% lower*4 | High risk |
Longevity | 5–10 years | Weeks to months |
Patient Satisfaction | High | Moderate to low |
After AVF surgery, most patients experience mild swelling or bruising around the surgical site, which resolves as the fistula heals. During this recovery period, it’s essential to monitor for complications like:
- Numbness or tingling in the hand, which is usually temporary.
- Pain or signs of infection, which should be reported immediately.
Regular follow-ups, including Doppler ultrasound and physical exams, ensure the fistula matures correctly and functions as needed.
Surgeons assess AVF success using:
- Ultrasound Testing: Measures blood flow and ensures the fistula is maturing.
- Physical Exam: Checks for the “thrill” or vibration that indicates proper blood flow.
- Angiography: Occasionally used to identify blockages or narrowing.
Australian Insight: AVF procedures performed by experienced vascular surgeons boast a success rate of over 85%, according to local studies.*5
Modern advancements in AVF procedures are transforming outcomes for patients:
- Minimally-invasive techniques: Endovascular methods allow surgeons to create fistulas using catheters and imaging, reducing recovery time and complications.
- Preemptive planning: Early referral for AVF creation in CKD patients ensures the fistula has time to mature before dialysis begins.
Earlier studies have indicated that preemptive AVF creation can lead to decreased mortality, reduced infection rates, and improved patency, underscoring the importance of early intervention.*6
After AVF creation, ongoing care ensures long-term success:
- Advanced imaging: Regular ultrasounds detect narrowing or blockages early.*6
- Innovative graft materials: For patients who can’t undergo AVF surgery, new synthetic grafts offer better durability and fewer complications.
Delaying AVF creation can lead to complications like infections or blood clots associated with temporary catheters.
Early planning ensures the fistula has sufficient time to mature, reducing risks and improving dialysis outcomes.
“An AVF is a crucial step in improving dialysis outcomes and quality of life,” says AVC’s Dr Jason Toniolo.
“Early planning helps improve outcomes and ensure smoother transitions to dialysis.”
Plan Early, Live Better – If you or a loved one is facing kidney disease, don’t wait to discuss AVF options with a vascular specialist.
Bulk-billed imaging and AVF services are available at AVC Gregory Hills, Wollongong, and Orange. Call us today on 02 4226 9333.
Sources:
- Differential Impact of Central Venous Catheters versus Arteriovenous Fistulae on Quality of Life among Irish Haemodialysis Patients | PubMed
- Outcomes of Arteriovenous Fistulas Versus Catheters | PMC
- Dr. Jason Toniolo – AVF Creation Details
- Hemodialysis – Tests and Procedures | Mayo Clinic
- The impact of a dedicated renal vascular access nurse on haemodialysis access outcomes|CambridgeMedia
- Vascular access for hemodialysis in the elderly | JVS