AV fistula for dialysis (Arteriovenous (AV) fistula formation for dialysis)

An operation that joins an artery to a vein, usually in the arm, to create a strong blood vessel that can be used for reliable haemodialysis once it has matured.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

An AV fistula joins an artery to a vein, usually in the arm, to make a strong blood vessel for haemodialysis.
It is generally the best long-term dialysis access, but it must mature first — usually around six weeks or longer — before it can be used.
Not every fistula matures or stays open; up to about one in five clot or fail to develop and may need a further procedure.
You will be taught to check daily for the fistula 'buzz' (thrill) and to protect the arm; loss of the buzz needs urgent contact.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSurgery (usually keyhole-sized cut, often under local anaesthetic)

AnaestheticUsually local anaesthetic; sometimes a regional block or general anaesthetic

How long it takesAbout 1–2 hours

Hospital stayUsually day case (home the same day)

Time off workUsually a few days; you should not drive immediately

When you'll see resultsThe fistula needs time to mature — usually around 6 weeks or longer before it can be used

On the NHS?Routinely provided on the NHS as part of kidney (renal) care; rarely a private self-pay choice

A general guide. Your surgeon will give you advice for your situation.

Best fit

Provides reliable, long-term access for haemodialysis

Pause if

Your arm veins or arteries are too small or diseased to form a working fistula, where a graft or line may be needed instead.

Main recovery point

Keep the arm elevated when resting to reduce swelling. Check that you can feel the buzz (thrill) over the fistula as you have been shown. Avoid leaning on...

Good aftercare

Clear teaching on checking the buzz (thrill) daily and what to do if it stops.

First 24–48 hours

Keep the arm elevated when resting to reduce swelling. Check that you can feel the buzz (thrill) over the fistula...

First 1–2 weeks

The wound heals and any stitches are dealt with as advised. Avoid heavy lifting with that arm and keep the wound...

Weeks 2–6

The fistula gradually enlarges and strengthens. Gentle hand exercises, such as squeezing a soft ball, may be...

Around 6 weeks or later

The fistula is checked, often with an ultrasound, to see if it has matured enough to use for dialysis. Some take...

Medical line illustration of haemodialysis circuit arm fistula for AV fistula for dialysis. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is an AV fistula for dialysis?

An arteriovenous (AV) fistula is made in an operation that joins an artery to a nearby vein, usually in the arm. This sends extra blood flow into the vein, so over several weeks the vein becomes larger and stronger. Once it has 'matured', it can be used to connect you to a dialysis machine.

Haemodialysis filters the blood when the kidneys can no longer do so. To do this, the machine needs a reliable way to take blood out and return it quickly. A mature fistula provides this and is generally considered the best long-term form of dialysis access, because it tends to last longer and have fewer infections than a graft or a tube (line).

The fistula is usually created on the inside of the forearm of your non-dominant arm where possible. A surgeon makes a small cut, joins the vessels, and closes the skin. It is often done under local anaesthetic.

A fistula is not used straight away. It needs time to develop, and not every fistula matures or stays open, so some people need further procedures or a different type of access.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Radiocephalic (wrist) fistula

Made at the wrist, joining the radial artery to a forearm vein. Often the first choice because it preserves veins higher up the arm for future use.

Brachiocephalic (elbow) fistula

Made at the elbow when wrist vessels are unsuitable. Tends to develop good flow but uses up a higher vein.

Brachiobasilic (transposed) fistula

Uses a deeper upper-arm vein that is moved closer to the surface so it can be needled. A more involved option for selected people.

AV graft (alternative)

If your own veins are not suitable, a soft synthetic tube can be used to join the artery and vein instead. It can be used sooner but tends to have more clotting and infection problems than a fistula.

Endovascular fistula (newer technique)

A newer keyhole method that joins the vessels using energy from inside the vein rather than open surgery. It is still being introduced in the UK and is not available everywhere.

Fistula vs graft vs line

Point	Fistula	Graft	Line
Made from	Your own vessels	Synthetic tube	Tube into a vein
Ready to use	Weeks (matures)	Sooner	Straight away
Infection risk	Lowest	Higher	Highest
Long-term durability	Best	Less	Least

A fistula is usually preferred for the long term, but the right choice depends on your veins, how soon you need dialysis and your overall health.

Preparing for your surgery

Protect the veins in your non-dominant arm: avoid blood tests, drips and blood-pressure cuffs on that arm if you can, and tell staff why.
You will usually have an ultrasound 'vein mapping' scan first to find the best vessels.
Tell the team about all your medicines, especially blood thinners, and ask if any need adjusting.
Mention any previous lines, fistulas or arm surgery, and any problems with your hands or circulation.
Ask whether you will have local, regional or general anaesthetic, and arrange a lift home as you should not drive immediately.
Wear loose sleeves so the arm can be examined and dressed easily afterwards.
Ask when the fistula is likely to be ready and how it will be checked before first use.

What happens

The operation is usually done under local anaesthetic, sometimes with a regional block or, less often, a general anaesthetic. You lie down with your arm supported.

The surgeon makes a small cut over the chosen artery and vein, usually at the wrist or elbow. The two vessels are carefully joined so that blood from the artery flows into the vein. The skin is closed with stitches, which may be dissolvable.

Straight after surgery, the team checks for a 'thrill' — a gentle buzzing you can feel over the fistula — which shows blood is flowing through it. The operation usually takes one to two hours, and most people go home the same day with advice on caring for the arm. You should not drive immediately afterwards.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Your arm veins or arteries are too small or diseased to form a working fistula, where a graft or line may be needed instead.
Poor circulation in the hand means a fistula could worsen blood supply (risk of steal syndrome).
You need dialysis very urgently and cannot wait the weeks a fistula takes to mature.
Severe heart problems where the extra flow from a large fistula could cause strain.

Delay surgery if…

There is an active infection, at the planned site or elsewhere.
Your blood-thinning medicine needs adjusting before surgery.
Vein mapping has not yet been done to choose the best site.
You are unwell or unstable and surgery would be unsafe at present.

Alternatives to discuss

An AV graft using a synthetic tube if your own veins are unsuitable.
A tunnelled dialysis line (catheter) for temporary or longer-term access.
Peritoneal dialysis, which uses the lining of the tummy instead of the bloodstream.
A fistula in the other arm or at a different site.
Conservative kidney care without dialysis in selected people, after discussion.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

Local anaesthetic

The most common choice; the area is numbed and you stay awake.

Regional block

Numbs the whole arm and can also help the vessels open up, used in selected cases.

General anaesthetic

Used less often, for example for more involved upper-arm fistulas or where it is safer for the patient.

Benefits

Provides reliable, long-term access for haemodialysis
Generally lasts longer than a graft or a line
Lower risk of infection than a graft or line
Uses your own blood vessels, with no permanent foreign material in most cases
Once matured, allows efficient dialysis with good blood flow

Risks & complications

More common

Bruising, swelling and tenderness around the wound at first
Some fistulas are slow to develop or do not mature enough to use
A visible, raised vein under the skin once the fistula develops
Mild aching in the arm in the early weeks

Less common

The fistula clotting off (thrombosis), sometimes needing a further procedure
Narrowing of the vein over time, which may need treatment
Reduced blood flow to the hand, causing coldness, tingling or pain (steal syndrome)
Wound infection or a small bleeding problem

Rare but serious

A swelling or weak spot in the vein wall (aneurysm) needing repair
Significant hand problems from reduced circulation, rarely affecting use of the hand
Heart strain from high flow through a large fistula, in selected people
Serious infection

The two biggest realities are that a fistula needs time to mature and that not every fistula works first time. Up to about one in five fistulas clot or fail to develop, so a backup plan for dialysis access matters. Reduced blood flow to the hand (steal syndrome) is uncommon but important. Ask your surgeon about your vein quality, how likely your fistula is to mature, and what the plan is if it does not.

Published figures to discuss

Whether a fistula matures and stays open depends on your vein quality, the site chosen, your circulation and your overall health, so outcomes vary between people. The clearest defensible figure is that a notable minority of fistulas fail early. Other risks, such as steal syndrome or aneurysm, are uncommon and vary by patient, so exact percentages are not given here.

Figure	Reported range	How to interpret it	Source / confidence
Fistula clots off or fails to mature	Up to around 1 in 5 (about 20%)	Patient information from Kidney Care UK; means a backup access plan is important.	Guy's and St Thomas' NHS Foundation Trust — Having an arteriovenous fistula formedguysandstthomas.nhs.ukPublished figure
Steal syndrome causing hand pain or poor circulation	Uncommon, but more likely with diabetes, peripheral vascular disease and upper-arm fistulas	Cold painful fingers, numbness or ulcers after fistula creation need urgent vascular review.	Guide sourcesClinical context
Fistula needing further procedure to mature or keep working	Common over the lifetime of dialysis access	Ultrasound, angioplasty, side-branch ligation or revision may be needed; fistula care is ongoing.	Guy's and St Thomas' NHS Foundation Trust — Having an arteriovenous fistula formedguysandstthomas.nhs.ukSource-linked context
Aneurysm, bleeding or infection from repeated needling	Recognised long-term risks	Buttonhole technique, needling rotation and prompt review of skin thinning or bleeding reduce risk.	Guy's and St Thomas' NHS Foundation Trust — Having an arteriovenous fistula formedguysandstthomas.nhs.ukSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

The wound usually heals quickly, but the fistula itself needs weeks to mature before it can be used. Most of 'recovery' is protecting and monitoring the arm while the fistula develops.

First 24–48 hours

Keep the arm elevated when resting to reduce swelling. Check that you can feel the buzz (thrill) over the fistula as you have been shown. Avoid leaning on or pressing the arm.

First 1–2 weeks

The wound heals and any stitches are dealt with as advised. Avoid heavy lifting with that arm and keep the wound clean and dry.

Weeks 2–6

The fistula gradually enlarges and strengthens. Gentle hand exercises, such as squeezing a soft ball, may be recommended to help it develop.

Around 6 weeks or later

The fistula is checked, often with an ultrasound, to see if it has matured enough to use for dialysis. Some take longer than six weeks.

Ongoing

Once in use, the fistula is monitored at each dialysis session for flow, narrowing or other problems.

What's normal — and not a worry

A gentle, constant buzzing (thrill) felt over the fistula
Bruising and mild swelling around the wound at first
A vein that becomes more prominent as the fistula develops
Some aching in the arm in the early weeks
Several weeks of waiting before the fistula can be used

Aftercare

Check your fistula every day for the buzz (thrill), and seek urgent advice if it stops or changes.
Keep the wound clean and dry, and follow advice about dressings and stitches.
Do not let anyone take blood, give injections, put a drip in, or use a blood-pressure cuff on the fistula arm.
Avoid heavy lifting, tight sleeves, watches or jewellery, and sleeping on the fistula arm.
Do any recommended hand exercises to help the fistula mature.
Watch for signs of poor circulation in the hand, such as coldness, pallor, pain or numbness.
Keep all kidney and surgical follow-up appointments so the fistula can be checked.

Before-surgery checklist

Know how to feel for the fistula buzz (thrill)
Someone to drive you home
Loose sleeves for the fistula arm
A soft ball for hand exercises, if advised
Emergency contact number for your renal unit
Note on your arm to warn staff not to use it for blood tests or cuffs
Follow-up appointment for fistula checking booked

Scars and how they heal

There is usually a small scar over the wrist or elbow where the vessels were joined. As the fistula develops, the vein under the skin becomes more prominent and may be visible and raised, which is normal and shows the fistula is working. Over time, repeated needling can change the look of the skin over the fistula.

⚠ Get urgent help if…

Loss of the buzz (thrill) over the fistula, or it suddenly feels different — contact your renal unit urgently
The hand becoming cold, pale, blue, numb, weak or very painful
Increasing redness, swelling, heat, pus or a high temperature (signs of infection)
Bleeding from the fistula or wound that does not stop with gentle pressure
A rapidly growing lump or swelling over the fistula
Severe arm pain or swelling

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is a fistula that matures and provides reliable, efficient dialysis access for years with few problems. Many fistulas do this and are the most durable form of access.

However, success is not guaranteed. Some fistulas do not mature, clot off or narrow over time, and may need further procedures or a different type of access. The quality of your veins, your circulation and your overall health all affect the outcome, so your team should be honest about your individual chances.

How long it lasts

A working fistula can last for many years, which is a key reason it is preferred for long-term dialysis. Even so, fistulas can narrow, clot or develop swellings over time, and they need regular monitoring. Some are kept working with extra procedures, such as widening a narrowed segment. How long yours lasts depends on your vessels, your dialysis needs and how well problems are picked up early.

Combining with other procedures

Fistula formation is part of a wider kidney care plan that includes the type and timing of dialysis, protecting future access sites, and managing your kidney condition. In some people, a temporary line is used for dialysis while the fistula matures, and is removed once the fistula can be used.

Follow-up & long-term care

Your fistula is usually checked around six weeks, often with an ultrasound, to see whether it has matured. Once it is in use, it is monitored at each dialysis session for flow and any narrowing. Problems such as a lost buzz, poor flow or a growing swelling are acted on promptly, sometimes with a further procedure to keep the fistula working.

Check the fistula buzz (thrill) every day and report any change.
Always protect the fistula arm from blood tests, drips and blood-pressure cuffs.
Attend monitoring at each dialysis session so narrowing or clotting is caught early.
Have any recommended procedures to widen a narrowed segment or treat a problem.
Keep the skin over the fistula clean and follow needling-site care advice.

Revision and secondary surgery reality

Some fistulas need a further procedure to widen a narrowed segment so they keep working.
If a fistula fails, a new fistula, a graft or a line may be needed.
Aneurysms or problem segments may occasionally need surgical repair.
Ongoing monitoring aims to catch and treat problems before the fistula clots off.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

Clear teaching on checking the buzz (thrill) daily and what to do if it stops.
Written advice on protecting the fistula arm from blood tests and cuffs.
A named renal contact and out-of-hours number for urgent problems.
Planned ultrasound and review to assess maturation before first use.
Ongoing monitoring at dialysis to catch narrowing or clotting early.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The vein-mapping ultrasound and assessment beforehand
The surgeon's fee and the type of fistula needed
The anaesthetic used (local, regional or general)
Theatre or facility costs and length of any stay
Follow-up checks, including ultrasound to assess maturation
Any further procedures if the fistula does not develop or narrows
Treatment of any complications

Make sure your written quote includes

The cost of vein mapping and assessment
The surgeon's fee and the anaesthetic fee
The facility or theatre fee
Follow-up appointments and the maturation ultrasound
What happens, and what it costs, if the fistula does not develop or clots
Cancellation policy
What happens if a complication occurs

On the NHS? AV fistula formation is routinely provided on the NHS as part of kidney (renal) care for people who need or are likely to need haemodialysis; it is rarely a private self-pay procedure.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

How good are my veins, and how likely is my fistula to mature?
Where will you place the fistula, and why there?
What is the plan if the fistula does not develop or clots off?
How will I be monitored, and how soon could I need dialysis?
What signs of poor hand circulation should I watch for?
Will I need a temporary line while the fistula matures?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Is an AV fistula done on the NHS?

Yes. Fistula formation is a routine part of NHS kidney (renal) care for people who need or are likely to need haemodialysis. It is rarely a private self-pay choice.

Why can't I use the fistula straight away?

The vein needs time to enlarge and strengthen after the artery is joined to it. This 'maturing' usually takes around six weeks or longer before the fistula is reliable enough to use.

Will the operation hurt?

It is usually done under local anaesthetic, so you should not feel pain during it, though you may feel some pushing. The arm can ache and bruise for a short time afterwards.

What if my fistula doesn't work?

Not every fistula matures or stays open; up to about one in five clot or fail to develop. If this happens, you may need a further procedure, another fistula, a graft or a line.

How do I look after my fistula arm?

Check the buzz daily, keep the arm clean, avoid heavy lifting and tight sleeves, and never let anyone use that arm for blood tests, drips or blood-pressure cuffs.

Why does my arm have a buzzing vein?

That buzz, called a thrill, is blood flowing from the artery into the vein. It is a normal and reassuring sign that the fistula is working. Losing it needs urgent contact.

Can the fistula affect my hand?

Occasionally, diverting blood into the vein reduces flow to the hand, causing coldness, tingling or pain (steal syndrome). Tell your team if you notice this, as it can sometimes need treatment.

Find a verified surgeon for av fistula for dialysis

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

No verified consultants list this procedure yet — browse the full directory.

See all surgeons for av fistula for dialysis →

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: Kidney Care UK — Arteriovenous (AV) fistula formation Kidney Care UK — Fistulas: your questions answered Guy's and St Thomas' NHS Foundation Trust — Having an arteriovenous fistula formed Gloucestershire Hospitals NHS — Forming an arterio-venous (AV) fistula

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.