Complications After AV Fistula or Graft Surgery
An arteriovenous (AV) fistula or AV graft is created to provide access for hemodialysis. An AV fistula connects an artery directly to a vein, while an AV graft uses a synthetic tube to connect them. Both help blood flow through the dialysis machine, but complications can occur after surgery.
Patients should know how to recognize infection, clotting, and poor blood flow so they can seek medical care promptly.
1. Infection After Surgery
Infection can develop around the surgical incision or, especially with a graft, along the artificial tube. Signs may include:
- Redness or increasing warmth around the incision.
- Swelling or worsening pain.
- Pus or unusual discharge.
- Fever or chills.
- Redness spreading beyond the wound.
What to do: Contact the dialysis or surgical team promptly if infection is suspected. Fever, spreading redness, or pus needs urgent medical assessment. Do not squeeze the wound or apply unprescribed creams.
2. Blood Clots and Access Blockage
A clot can block an AV fistula or graft and prevent dialysis access from working properly. Signs include:
- The usual vibration, called a thrill, becomes weaker or disappears.
- The access no longer makes its usual buzzing sound.
- The dialysis machine reports poor blood flow.
- The access becomes swollen or painful.
- Dialysis staff have difficulty using the access.
What to do: Contact the dialysis team or access surgeon immediately if the usual thrill disappears or the access suddenly stops working. A blocked access may need urgent treatment to restore blood flow. Do not massage or press firmly on the access.
3. Poor Blood Flow to the Hand
Sometimes, blood is diverted through the fistula or graft, reducing circulation to the hand. This is known as access-related hand ischemia or steal syndrome.
Warning signs include:
- A hand or fingers that feel unusually cold.
- Pain in the hand, especially during dialysis or exercise.
- Numbness, tingling, or weakness.
- Pale or bluish fingers.
- Sores that heal slowly.
What to do: Report new hand pain, coldness, or numbness to the access team promptly. Severe or sudden pain, a pale or blue hand, new weakness, or loss of sensation requires emergency assessment because the hand may be at risk.
4. Bleeding and Bruising
Some bruising and mild swelling can occur after surgery. However, bleeding that continues, rapidly increasing swelling, or a wound that opens can indicate a serious problem.
What to do: For bleeding, apply firm, direct pressure over the bleeding point with clean gauze and seek urgent medical help. If bleeding is heavy or does not stop, call emergency services. Do not wrap the entire access arm tightly.
5. Swelling and Narrowing of the Blood Vessel
Narrowing of the vein or nearby blood vessels can reduce access flow. Patients may notice swelling of the arm or hand, prominent veins, prolonged bleeding after dialysis needle removal, or repeated problems during dialysis.
What to do: Contact the dialysis team if swelling increases or dialysis becomes difficult. The team may arrange an ultrasound or other tests to check blood flow and identify narrowing.
6. Aneurysm or Bulging of the Access
Over time, part of an AV fistula or graft may become enlarged or bulge. A small, stable bulge may not be an emergency, but rapid enlargement, thinning or shiny skin, scabbing, or bleeding can indicate a serious problem.
What to do: Have new or changing bulges assessed by the access team. Sudden bleeding or skin breakdown over the access requires emergency care.
7. Other Possible Complications
Other complications include blood clots in nearby veins, prolonged wound healing, nerve irritation, and, less commonly, excessive blood flow that places extra strain on the heart. Persistent hand weakness, significant arm swelling, or new breathlessness should be reported to a healthcare professional.
How Patients Can Check Their AV Fistula or Graft
Once the surgical team explains how to check the access, patients should:
- Feel for the usual gentle vibration over the access each day.
- Look for redness, discharge, swelling, or skin changes.
- Check whether the hand feels warm and has normal colour and sensation.
- Follow the team's instructions about keeping the wound clean and dry.
- Avoid tight clothing, heavy pressure, or blood pressure cuffs on the access arm unless a clinician specifically directs otherwise.
When to Seek Medical Help
Seek emergency care for uncontrolled bleeding, sudden severe hand pain, a cold or blue hand, sudden loss of sensation or movement, or signs of a severe infection such as confusion or marked weakness.
Contact the dialysis team or access surgeon immediately if the thrill disappears, the access stops working, or you suspect a clot or infection. Early treatment can help preserve the access and prevent more serious complications.
