AV Fistula Surgery Melbourne
An arteriovenous fistula (AVF) is a surgical connection between an artery and a vein, typically created in the arm, to provide reliable vascular access for haemodialysis. The AVF is considered the gold-standard access for long-term dialysis due to its durability, lower complication rates, and superior outcomes compared to grafts or catheters. Once matured, the fistula provides a high-flow access point that can be needled repeatedly for dialysis treatments. Dr Dias has extensive experience creating AVFs using various configurations to suit individual patient anatomy.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- Gold-standard dialysis access with best long-term outcomes
- Lower infection rates compared to grafts and catheters
- Longest functional lifespan of all access types (years to decades)
- Lower risk of thrombosis (clotting) than grafts
- Uses patient's own blood vessels - no foreign material
- Lower overall healthcare costs due to fewer complications
- Better dialysis adequacy and patient survival
The Procedure
AVF creation is typically performed under local anaesthesia with sedation, or regional nerve block. The most common configurations are radiocephalic (wrist), brachiocephalic (elbow), or brachiobasilic (upper arm with vein transposition). Through a small incision, an artery and vein are surgically joined, allowing arterial blood to flow directly into the vein. This increased flow causes the vein to enlarge and thicken (mature), making it suitable for repeated needle access. The procedure takes 1-2 hours depending on complexity. Preoperative vein mapping with ultrasound helps plan the optimal fistula configuration.
Who Is a Candidate?
AVF creation is recommended for patients with chronic kidney disease approaching or already requiring haemodialysis. Ideally, referral occurs when kidney function falls below 20-25% to allow time for fistula maturation before dialysis is needed. Good candidates have adequate veins visualised on preoperative ultrasound mapping. Factors affecting suitability include vein quality and size, arterial disease, previous IV cannulations or blood draws, diabetes, and overall health status. Even patients with suboptimal veins may be candidates with advanced surgical techniques.
Recovery
AVF creation is usually a day surgery procedure. The arm may be sore and swollen for a few days - elevation and simple analgesia help. Avoid blood pressure measurements, blood draws, or IV cannulas in the fistula arm. Begin gentle hand exercises (squeezing a ball) after 1-2 weeks to promote maturation. The fistula typically takes 6-12 weeks to mature before it can be used for dialysis. During this time, alternative access (catheter) may be needed if dialysis is required. Regular monitoring ensures the fistula is developing well.
Risks & Considerations
AVF surgery risks include bleeding, infection, and nerve injury (causing numbness or weakness, usually temporary). Specific AVF complications include failure to mature (15-30%), thrombosis (clotting), stenosis (narrowing) requiring intervention, steal syndrome (hand ischaemia due to blood diversion, uncommon), aneurysm formation over time, and high-output cardiac failure (rare, with very high-flow fistulas). Not all fistulas mature successfully; some patients require revision surgery or alternative access. Dr Dias will discuss your individual anatomy and expected outcomes.