End Stage Renal Disease
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Your vascular surgeon will give you the necessary instructions you need to follow before the surgery, such as fasting. Usually, your physician will ask you not to eat or drink anything 8 hours before your procedure. Your physician will discuss with you whether to reduce or stop any medications that might increase your risk of bleeding or other complications.
Typically, this procedure is done on an outpatient basis. Most often, a patient will first be sedated and then a surgeon will numb the area where the fistula or graft will go. In some cases, an anesthesiologist may put you to sleep.
Depending upon the quality of your artery and vein, the surgeon will try to construct the fistula with one incision using the forearm of the arm that you do not use as frequently. For example, if you're left handed, your physician will place the fistula in your right arm, if possible. To perform the surgery, your physician joins an artery and a large vein under the skin. The physician divides your vein and sews it to an opening made in the side of the artery. As a result, blood flows into the veins that lead back to your heart, and also down the arteries into the hand. The blood normally traveling in your divided vein goes back to the heart through other veins, and there is usually plenty of blood remaining in your artery to supply your hand.
If you cannot receive a fistula because the vein is too small or blocked, your physician may construct a graft using a tube of man-made material. Less commonly, your physician may also choose to use a piece of a vein from your leg or a section of artery from a cow as alternative graft materials. Your physician sews the graft to one of your veins and connects the other end to an artery. Your physician may place the graft material straight or form a loop under the skin either in your lower arm, upper arm, or less commonly in your leg.