An arteriovenous (AV) fistula, commonly referred to as a Cimino fistula, is a critical component in hemodialysis treatments for patients with kidney failure. This medical procedure involves creating a direct connection between an artery and a vein, typically in the arm, to facilitate efficient AV fistula dialysis.
Purpose of AV Fistula
1. Hemodialysis Efficiency
The primary purpose of an AV fistula is to provide an efficient and reliable vascular access for hemodialysis The fistula increases blood flow to the vein, enlarging and strengthening it. The enhanced vein size and durability make it easier and safer to insert AV fistula dialysis needles.
2. Longevity and Lower Complication Rates
Compared to other vascular access types, such as catheters and grafts, AV fistulas generally have a longer lifespan and fewer complications. They are less prone to infections and clotting, making them a safer choice for long-term dialysis.
Types of AV Fistulas
– Cimino fistula (Radiocephalic Fistula)
The Cimino fistula, named after Dr. Brescia and Dr. Cimino, the creators of the technique, is the most common type of AV fistula. It typically involves connecting the radial artery to the cephalic vein in the forearm.
– Upper Arm (Brachiocephalic Fistula) AV Fistula
In cases where the veins in the forearm are not suitable, an upper arm AV fistula may be created by connecting the brachial artery to a nearby vein, such as the basilic vein.
– Brachiobasilic Fistula:
Another upper arm fistula option is connecting the brachial artery to the basilic vein. This type of fistula may require two surgeries: one to create the fistula and another to transpose the vein (move it closer to the skin surface).
Rarely, other sites may be used for AV fistula creation if the patient’s vascular anatomy requires it. These instances are less common and often necessitate more complex surgical procedures. Examples include the transposition of other veins or the use of alternate arteries and veins when the typical sites are not viable.
AV fistulas are a cornerstone of effective AV fistula dialysis treatment, providing a durable and safe vascular access for patients with kidney failure. Understanding the purpose and types of AV fistulas, including the common Cimino fistula, is essential for healthcare providers and patients managing end-stage renal disease. Through proper care and management, AV fistulas can significantly improve the quality of life for those undergoing regular AV fistula dialysis.