Fistula question?

[Alex C.]

I'm still pre-daialysis, but had fistula surgery 2 weeks ago. The surgeon says that my surgery was essentially not successful, and now he's sending me down for vein-mapping, to see what we can do about it.

My question is this: Shouldn't he have done this BEFORE my surgery? Is this a common procedure, or did he 'drop the ball'? I just got a co-pay request for $250 for a surgical procedure that was a failure!

Should I ask him to waive my co-pay if it was his error? Or should I just wait for the SECOND surgery, THEN bring this up with the hospital? Or, should I ask for a different surgeon?

[cattlekid]

I'm not understanding why they would have done the surgery without the vein mapping first.  I had two vein mappings done prior to my fistula surgery.  How else would they know where to start? 

I would insist on a vein mapping at their expense and probably a different surgeon as well.  I'm sorry you had to go through this.

[noahvale]

^

[Hazmat35]

How could they have done the surgery without mapping it out first.  That is crazy to me.  How do they know which is the correct Vien / Artery to use.  There are so many to choose from, and they have to use the best choice, not just pick the one that is the easiest. 

Personally, I wouldn't go back to the same Surgeon.  I'd find a different one.  Who says that the 2nd time he/she will do any better. 

I think that a "skilled" surgeon would INSIST on mapping first.  I know that I would. 

[Relentless]

I would tell him you ain't paying for sh@t. My first surgeon did the same thing and it fell.  Nephrologist told me tht they should of done vein mapping first. Went for vein mapping and they sd tht my veins were to small to have fistula and first surgeon should of known if he had mapping done. Went to a different vascular surgeon and he agreed tht first surgery was a waste of time and my pain.  You want to tlk about high blood pressure, you should checked it when I heard tht. Now I have a graft.

[sullidog]

I wouldn't even touch a surgeon like that with a 10 ft poll and my neph won't let me either.

[MightyMike]

Yes this more or likely could of been avoided by getting the vein mapping first because at least that way they could of found the best area to use before cutting into you and making a mistake like that.

[Alex C.]

Well, the vascular surgeon called me back today. Seems that my RIGHT arm is the better arm, and he wants to do a second fistula surgery there. Problem, though; I'm right-handed, and I'm not crazy about having my dominant arm stuck 3x/week. Also, I would be unable to write for several days after the surgery, essentially putting me out of  work AGAIN, and using up the rest of my vacation time.

OK, what should I do now? Ask for more noticeable access higher up on the left arm, or go for the right arm? Or, should I just go to a different surgeon?

[cdwbrooklyn]

Alex, when I was in-center, there was a patient who had her fistula in her leg.  She didn’t have any good veins in her arms.  It seems to work well for her because she was very happy with it.   If you are okay with it, maybe you can ask you surgeon to try the upper part of your leg.   Just my suggestion as I do understand the use of your right hand.

[Sue]

I had to have my fistula in my dominant right arm after vein mapping showed that the veins in my left arm were not big enough to use. As i want to do home hemo when my time comes i am pretty concerned about how i will manage! Thing is tho alex a strong working fistula is the main thing .

[noahvale]

*

[amanda100wilson]

this is my penny worth.  you need to dow a runner from that surgeon as he sounds like a dabbler in fistula surgery and doesn't sound like he knows what he is doing.  He  should have vein-mapped you first.  I went to five surgeons and all referred to vein mapping even though I didn't think ver highly of them which is why I saw so many.  surgeon two did fistula formation on at wrist level on non-dominant arm. it never worked and I lost faith in him pretty quickly.  I eventually found a surgeon who made a fistula on non dominant arm at elbow-level. I needed two further surgeries to get the vein in the right place and accessible for dialysis.  this is called a vein transposition and is fairly standard with fistulas made at this location because the vein they use is deep.   it also tends to take longer to mature.  in my case, it took about a year.

I was adamant that the fistula was not going to be placed in my dominant arm before using this location.  in my case I switched doctors since if they were prepared to jump in on my other wrist, it suggested to me that they weren't very competent at this type of surgery.

if you have veins that are too small on one side, it suggests he same is likely to be true.  If I were you, I would seek out another doctor. do not them let them use your dominant arm unless there is no other option, and that has been determined by vein-mapping.
 I am pretty sure that they won't waive the co-pay but you may try since the doctor should have vein-mapped you as it is standard practice.

[amanda100wilson]

just another thought.  if the surgeon does go for your dominant wrist, suggest that you ask him to put a graft in your wrist.  although a fistula is usually preferred, the mind-set behind what I have suggested is that by having a graft there will tend to mature the veins in your upper arm so that if down the one you need to have an upper arm fistula, you won't have to wait so LNG t use it because the veins will already be mature.

[sullidog]

after my graft in my left arm kept clotting off, my surgeon switched to my right arm which that's the hand I use because my left arm my veins are too small. I have had no problems using that hand and it's an upper arm graft. And yes you should only use the leg as a last resort as it is not very sanitary down there and a good surgeon would tell you this as my new one did.

[lmunchkin]

John had a fistula put in his dominant arm (vessels were weak in other arm).  Has had it almost 3 yrs now and no problems. When VS first did it, he had to go in and tie off some offshoots, but its been a go ever since.  He is an excellent VS and he did mapping! 


God Bless,
lmunchkin

[Alex C.]

this is my penny worth.  you need to dow a runner from that surgeon as he sounds like a dabbler in fistula surgery and doesn't sound like he knows what he is doing.  He  should have vein-mapped you first. 

Actually, he seems to be the 'number 1 provider' of fistulas locally, and he's associated with a major teaching hospital.

[amanda100wilson]

just because he's with a teaching hospital does not necessarily mean that he is good.  this is speaking from twenty three years of experience with renal failure.  my transplant neph was with a major teaching hospital and although I can't prove it, his actions hastened the demise of my transplant.

[M3Riddler]

I'm still pre-daialysis, but had fistula surgery 2 weeks ago. The surgeon says that my surgery was essentially not successful, and now he's sending me down for vein-mapping, to see what we can do about it.

My question is this: Shouldn't he have done this BEFORE my surgery? Is this a common procedure, or did he 'drop the ball'? I just got a co-pay request for $250 for a surgical procedure that was a failure!

Should I ask him to waive my co-pay if it was his error? Or should I just wait for the SECOND surgery, THEN bring this up with the hospital? Or, should I ask for a different surgeon?

It doesnt matter how much experience a surgeon may have, you should have had a workup beforehand. You should have had an extensive doppler ultrasound of both arms and perhaps even your legs for future reference/issues. Even a vein mapping of both arms should have been done. 
A surgeon cannot tell by looking at your veins, even if you do have larger ones. I would defintely get a second opinion from a facility that is not associated with the current.  To me, they have dont things backwards. I would raise a stink and let your nephrologist know that you are unhappy.
They may do hundreds of them, but that is no excuse not to do a full workup.

Also, you should educate yourself. Dont be afraid to ask questions. If they are negative to your questions or tell you to leave it up to them, this is the first sign for you to find somewhere that will listen and accept your questions with respect.

///M3R

[Cordelia]

I had a lot of mapping done before my surgery. I had forgotten just how much....I had quite a few ultrasounds.   I remember being told that I had small veins so it was a bit tricky at first to map it all out.