In end stage renal failure, a persons kidneys are no longer able to filter the blood to remove toxins and fluid. A dialysis machine is therefore required to perform this job.

The dialysis machine removes the patients blood by draining it from the patients vein, filters it, and then returns it to the patient.

A vascular surgeon is required to create dialysis access.

There are three main methods in which dialysis access is created.

Arterio-venous fistula - This involves joining an arm vein to a nearby artery, which is called an arterio-venous fistula. This allows the vein to have more blood flowing through it, which allows the dialysis machine to filter your blood more efficiently.

Loop fistula - Otherwise called an arterio-venous graft. This uses a synthetic vein to join an artery and vein in people who do not have suitable veins for another arterio-venous fistula.

Vascath - Dialysis can also be performed via a vascath’ which is a tube usually placed into the large vein in the neck. The tip of the vascath sits just above the heart, and the other end can be connected to a dialysis machine.

Your renal physician will discuss this with you, with consideration of factors like:

• How quickly your kidneys have failed

• Your medical history

• The suitability of your veins and arteries to form a fistula

Once discussed with your renal physician, Dr Shiraev and yourself will discuss the options, and come up with a treatment plan that suits you.

Fistulas need to mature before they can be used for dialysis access. It can take at least six weeks for a fistula to mature, but some can take much longer.

If the veins or arteries are small to begin with, the maturation process may be slow.

Sometimes, this maturation process can be sped up by a keyhole procedure called a fistuloplasty, where a balloon or stent is used to dilate the vein (make the vein bigger). This allows the fistula to be used sooner.

Any operation requiring a general anaesthetic has risks like stroke, heart attacks, respiratory failure, or death.

However, most operations for forming arterio-venous fistulas are performed under a ‘regional block’, where the arm is put to sleep with local anaesthetic.

Risks associated with dialysis access operations are often prevented by careful planning and treatment. While these can be life- or limb-threatening, they are actively watched for, and if they occur are immediately managed.

The main risks of interventions for creating dialysis access are:

• Bleeding or bruising

• Reduction of blood supply

• Nerve injury

• Infection

• Slow-healing wounds