Fistula problem. Choosing among solutions

[RightSide]

On April 3, I had an operation on my left forearm near my wrist to create an AV fistula.

Today, my surgeon checked it, and told me that there's a clot about an inch long midway inside the vein.  There's no "buzz" after that; so the fistula is useless.

We discussed three options:

1.  Create a new fistula in my upper arm.  And then waiting another 2-3 months for it to develop.

2.  Try to splice out the clotted part of the vein, replaced with a vein taken from elsewhere in my body.  This would require slicing open a long incision, along most of the length of the fistula vein.  And then waiting for it to develop.

3.  Install a graft at the fistula site.  This can get done quickly, but grafts don't last as long and can get infected (though not as easily as the catheter I've got now).

Opinions?

I'm not happy about having to wait another 2-3 months for more blood vessel development--I'm taking a risk on infection with the catheter I've had since October.   But if that's the ideal way to go, then I would seriously consider it.  Otherwise, I'll go with the graft.

Any thoughts?
Any similar experiences?

[dwcrawford]

My thought is I'd throw a fit.... that's a downer.

[jbeany]

I wouldn't go with option 1 until you have no other choice.  Spaces for putting access points are at a premium - don't give up on one until you have no other choice.  2 or 3 seem like better options to me - at least try to make it work.  A graft isn't too bad.  I'm using a graft, and it's been over 2 years with it.  That's longer than the docs expected it to work.  Your own veins are always the best.  I think I'd try to rework it first with your own tissue.  JMO.

[YLGuy]

My first fistula was done on the side of my wrist.  It only worked for a couple of days and then the doctor could not feel the thill.  He did the second fistula 1" down from the first.  That was April 1st.  They just accessed the fistula with 1 needle today for the first time.  I am knew to all this and wish I had found IHD sooner. 

[Rerun]

Grafts use to be the BIG thing to do.  I think they quit them because they worked so well they got no generation of any more surgeries.  My friend has had one for years!  Never an infection.  I have begged for one and they won't give it to me. 

I'd try the graft.  Good luck.

[Dan.Larrabee]

Rather than graft in a vein from someware else, can they graft in a graft over the clotted spot. you will have a graft to fix the problem, but still have a fistula grow for years of sticks or button.

Sorry, just me being a dumb engineer.

[Ken Shelmerdine]

Dan Re- your avatar. If you're peeing in the sink, just bare in mind that some dirty B*****d may have washed their hands in there before you peed in it!

[Ken Shelmerdine]

Hi Right Side.
In my short experience of Haemo many people have told me that fistulas placed in the upper arm after a lower arm fistula has not worked more often than not are successful. I'd go for the upper arm fistula even if you do have to wait months, it will be worth it in the end.

I think Rerun's comment about grafts is very interesting. Maybe graft surgery is purposely undersold.

[Dan.Larrabee]

Dan Re- your avatar. If you're peeing in the sink, just bare in mind that some dirty B*****d may have washed their hands in there before you peed in it!

Ken, I would like to buy a Vowel......ha ha.

I agree, my graft works great, however  I just don’t know how the heck it will last for a few years, let alone 10. After sticking mine for only a few months, I can tell it’s getting warn out. It used to be tough to get the needle in, now it’s like butter. How many times can you stick a 15 gage needle into a straw and not expect it to fall apart after a while.   

[jbeany]

Life expectancy on a graft is supposed to be only 1 year.  I know kitkat is going on her 8th year with hers, and I'm on my 2nd, but that's not the usual outcome.  A real fistula can last for decades if it's done right and treated well.