Brand New AV Fistula Placement Today. Please help.

[Lexxtech18]

Just got home from the hospital. I had an AV fistula created in my right upper arm and I'm wondering a few things. It's been about 8 years since my first fistula was created (upper left arm) and it lasted about 4 good years, so I don't really remember the specifics. Anyway, with it being in my upper arm...

1.) what are the chances that it will develop properly?
2.) should I be doing any exercises to aid in proper development?
3.) is it normal for my whole forearm to be numb post-surgery? And should it go away soon?
4.) if for some reason it doesn't develop properly is there anything they can do to go back and fix it or will it just be abandoned and a graft put in?
5.) if it does develop properly, should I consider buttonholes?
6.) is there any way to keep aneurysms from forming on my new fistula?

My surgeon/care team didn't really give me many detailed after care instructions besides don't sleep/lay on that arm. So any info would help greatly. Thanks all.

[Angiepkd]

Hi Lexxtech!  I have a left upper arm fistula that was created after the wrist attempt failed.  I have big veins, but small arteries, which is unusual and can cause the fistula not to mature.  I am happy to say it developed wonderfully.  In fact, it matured so well that I recently had to have a surgery to reduce the flow.  Post-op I was given a ball to squeeze to help it develop.  However, check with your surgeon to see when you should start to use it.  If I remember right, I was given the ball at my 3 week appt. after surgery.  My arm was numb for a few weeks and then most of the feeling came back.  I still have a numb spot at my wrist, probably from the closure of my first fistula attempt.  I was sent to the access center 3 times for narrowing in my current fistula before it was deemed "good" by the vascular doc.  They kept ballooning until they got it right lol!  I was given a prescription for button holes by my nephrologist (a requirement for DaVita to allow me to use them).  He said they will prolong the life of my fistula.  They can be a little tricky, but stick with them if you decide to use that method.  The benefit of the button holes is fewer aneurysms, I am told.  Good luck with the new access!  Don't get frustrated if it takes a little tweaking to work properly.  The vascular docs will get it right, eventually!  The experts here have been really helpful!  I am sure you will get some good advice.

[MooseMom]

I have an upper arm fistula, and it developed perfectly.

Both my surgeon and my neph told me that I didn't need to do specific exercises but should just use my arm normally.  But that could be because I was not needing dialysis just yet, so I didn't need my fistula immediately.

My forearm was numb for a while, and as the feeling returned, I'd get these lightning sensations down my arm.  That lasted for many months.

I've always understood that buttonholes greatly reduced the risk of developing aneurysms.

[Riki]

It's been 3 and a half years since my fistula was placed, and it's an upper arm fistula.. I'll try and answer your questions. *G*

1.) what are the chances that it will develop properly?
2.) should I be doing any exercises to aid in proper development?
3.) is it normal for my whole forearm to be numb post-surgery? And should it go away soon?
4.) if for some reason it doesn't develop properly is there anything they can do to go back and fix it or will it just be abandoned and a graft put in?
5.) if it does develop properly, should I consider buttonholes?
6.) is there any way to keep aneurysms from forming on my new fistula?

1.  I would say that the chances depend on your veins.  How well did your last fistula develop?

2.  I was given a a stress ball to squeeze (it was actually shaped like a kidney).  I was told that it would help the circulation through the vessels and help them to develop.  I just kept it around and if I was just sitting watching tv, I'd squeeze it and hold for 10 seconds, then let go, and do that over and over again till my hand got tired or I got bored with it.

3.  I think it depends on how your surgery was done.  I had a nerve block, I think it was called, which uses your own nerves to numb the area (I think, I'm going by memory).  My whole arm was dead till sometime the next day.  When I went to leave the hospital after the surgery, I forget how it happened, but my arm fell and smacked me in the face, and I didn't realize it was my arm because I couldn't feel it.

4.  I can't really answer that one.  Here, they prefer to not use graphs, and will only use them if they absolutely have to.

5.  Buttonholes are always a good idea.  If I could put my own needles in, I'd probably have created buttonholes in my fistula.

6.  I really don't know that one.  I have pseudo aneurysms in mine, and except for one particular site, where the pseudo aneurysm is rather large and they prefer not to use it, they're not really concerned about them.

Hope this helps