Overview
An arteriovenous fistula is a disruption of the normal blood flow pattern. Normally, oxygenated blood flows to the tissue through arteries and capillaries. Following the release of oxygen in the tissues, the blood returns to the heart in veins. An arteriovenous fistula is an abnormal connection of an artery and a vein. The blood bypasses the capillaries and tissues, and returns to the heart.
Symptoms
When congenital arteriovenous fistulas are near the surface of the skin, they may appear swollen and reddish blue. In conspicuous places, such as the face, they appear purplish and may be unsightly.If a large acquired arteriovenous fistula is not treated, a large volume of blood flows under high pressure from the artery into the vein network. Vein walls are not strong enough to withstand such high pressure, so the walls stretch and the veins enlarge and bulge (sometimes resembling varicose veins). In addition, blood flows more freely into the enlarged veins than it would if it continued its normal course through the arteries.
As a result, blood pressure falls. To compensate for this fall in blood pressure, the heart pumps more forcefully and more rapidly, thus greatly increasing its output of blood. Eventually, the increased effort may strain the heart, causing heart failure. The larger the fistula, the more quickly heart failure can develop.
Diagnosis/Preparation
These tests include, but are not limited to: -- Serum creatinine, found in higher levels in the blood if kidneys fail.
- Urinary creatinine, lower in kidney failure.
- Urinary output, measuring both fluid intake and all urine produced.
- Urinary osmolality, measuring the concentration of the urine, an indicator of kidney filtering ability.
- Blood urea nitrogen (BUN), harmful nitrogen waste that increases in the blood as kidney function decreases.
- Electrolytes in blood and urine, minerals that result from the breakdown of salts (sodium, potassium, magnesium, and chloride), often out of balance when kidneys fail. Potassium, for example, increases in the blood during kidney failure and can cause heart irregularities.
Treatment
Small congenital arteriovenous fistulas can be cut out or eliminated with laser coagulation therapy. This procedure must be done by a skilled vascular surgeon, because the fistulas are sometimes more extensive than they appear to be on the surface. Arteriovenous fistulas near the eye, brain, or other major structures can be especially difficult to treat.Acquired arteriovenous fistulas are corrected by a surgeon as soon as possible after diagnosis. Before the surgery, a radiopaque dye, which can be seen on x-rays, may be injected to outline the fistula more clearly in a procedure called angiography
After Surgery
The incision will be bandaged to keep the area clean and prevent infection. (A nurse may briefly remove the bandage and check the stitches shortly after surgery.) You'll need to stay in bed until the doctor says it's safe to get up. As you begin your recovery, you can expect the following:- Oxygen: -At times during your stay, your body may need extra oxygen. It is given either through a plastic mask over your mouth and nose or through nasal prongs. If the oxygen dries out your nose or the nasal prongs bother you, tell your nurse, but don't take off the oxygen on your own.
- Deep Breathing and Coughing: - These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
- Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
- Incentive spirometer (spy-ROM-uh-tur): - This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
- Strict Intake/Output: - Your doctor may need to know the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an "I&O"
- Unless told otherwise, drink 6 to 8 large glasses of water each day. Keep a record of exactly how much liquid you drink.
- Your output of urine may have to be measured. Ask your doctor whether it's OK to use the toilet.
- Bruit: - This is the sound or feel of blood flowing through the fistula. Doctors will use a stethoscope or their fingers to check the flow.
- Medicines: -
- Antibiotics: - These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
- Pain Medicine: - To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or keeps coming back.
- Anti-Nausea Medicine: -This medicine calms your stomach and controls vomiting. Your doctor may suggest you take it at the same time as your pain medicine, which sometimes upsets the stomach.
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