A fistula is a natural type of vascular access where a person’s own vein is surgically connected to an artery. This procedure may be performed by a vascular surgeon as an outpatient operation using a local anesthetic. The increased blood flow that results from this connection causes the vein to grow bigger and stronger. The patient is taught to do exercises—such as squeezing a rubber ball—to help the fistula strengthen and mature to get it ready for use. This process takes anywhere from 6 weeks to 4 months or more. Once the fistula has matured, it can provide good blood flow for many years of dialysis.
Kidney and dialysis experts, including the National Kidney Foundation (NKF), Centers for Medicare and Medicaid Services (CMS), the American Association of Kidney Patients (AAKP) and others consider the fistula the “gold standard” in access choice. Research studies have proven that patients with a fistula have the fewest complications such as infection or clotting compared to all other access choices available.
Currently, an access improvement initiative known as Fistula First is being sponsored by CMS throughout the US to support an increase in the use of fistulas in dialysis patients.
The fistula is considered the “gold standard” access because it:
- Has a lower risk of infections than other access types
- Has a lower risk of forming clots than other access types
- Performs better than other access types
- Allows for greater blood flow
- Lasts longer than the other access types
- Can last many years, even decades, when well cared for
Not everyone may be able to have a fistula due to weak arteries, veins or other medical conditions. It is best to discuss your access options with your doctor, but be sure to ask for a fistula first.