Fistula surgery vs PD catheter surgery

[Willis]

I'm pretty well settled on going with PD so will probably be scheduling surgery for April. I got my cardio clearance today. I'm wondering if it's possible to get the catheter inserted and also have surgery for a fistula at the same time? I don't have insurance so going with home PD and Medicare is my only payment option. I think I want a fistula (don't I?) even if going on PD so I have a backup plan. So getting them both at the same time might be harder physically for a few days but one visit to the hospital will certainly be cheaper if the surgeon is willing.

 

[boswife]

You will have insurance wont you since you'll be on Dialysis?  I think it goes out to everyone if in US..  And, i know others have the back up fistula and i would get them done at the same time if thats possible.  (have NO idea if it is or not)  I hate 'procedures' so getting them out of the way would be important to me.  Fistula takes time to mature and it would be super nice to have ready if ya need it.  Best to you... and im sure you'll get some more concrete answers from others.. Just hang in here 

[Sugarlump]

If they will do it at the same not a bad idea, I went on PD first and it wouldn't work for me at all, the fluid kept going in but not much came out.
I looked like the Michelin Man!!! After 10 days had emergency admission to hospital for neckline and emergency haemodialysis in a big rush which
really threw me into a panic!
Good luck!

[pdpatty]

I was on PD for about 4 months and sprung a leak and ended up with  a whole bag of solution on my butt!(It migrated)
I had my PD cath in for about 4 mos before I used it. They also fixed a rupture in stomach at same time.

The only thing I could see is if you needed a vascular surgeon for the fistula. I had different docs each time..

If you are on Medicare ,you really should have a secondary insurance . It will cost but if you can't afford it ,maybe you should look into your states Medicade to be your secondary and you won't be billed.

[Jie]

I asked this question to different doctors, and there are different opinions. If the PD works well until you have a transplant, then the fistula is an unnecessary surgery. On the other hand, if the PD does not last long and you need HD, then the fistula is the right thing to do. I decided not to do fistula and it turns out to be a good decision for me.

[noahvale]

^^

[Willis]

FWIW...an update.

The vascular surgeon says he wants to make the fistula first and then after 2 weeks if it's healing OK he'll schedule surgery for the PD catheter. He said he has done both at the same time before when patients have absolutely insisted on it and they were reasonably healthy, but he also said most of them have said they wouldn't do it again. He said I'd be under anesthesia much longer and risk more after effects and would probably miss more work and have more pain if both were done at the same time. His arguments were convincing about doing the surgeries separately.

So now it looks like fistula surgery sometime in April which is good because my creatinine is over 8 now and I'm starting to feel very weak with lots of headaches. Though I'm not really looking forward to dialysis, I'm going to need it soon and hoping it will make me feel better. 

 

[Jie]

Well, if you are not doing them at the same time, then why doing fistula now? If you plan to have a transplant, there is a good chance that you will not need fistula at all. PD should be able to last for a few years.

[Willis]

Well, if you are not doing them at the same time, then why doing fistula now? If you plan to have a transplant, there is a good chance that you will not need fistula at all. PD should be able to last for a few years.

My thought is that the fistula takes a lot longer to be ready and even if I wind up doing PD (not 100% decided on that yet), then I'd want a fistula as a backup anyway. Maybe I will be the lucky PD patient to never get an infection or peritonitis and then get a transplant and never need hemo in the process...not sure I've ever been that lucky.

Also, it will give me a little more time to make sure PD is the right choice, but if not I'll have the fistula.

This is all new to me so I have a million things swirling around in my head.