Arteriovenous fistula: An irregular blood vessel connection-Arteriovenous fistula - Diagnosis & treatment - Mayo Clinic (2024)


To diagnose an arteriovenous fistula, a health care provider may use a stethoscope to listen to the blood flow in the arms and legs. The blood flow through an arteriovenous fistula makes a sound like humming.

If your provider thinks you have a fistula, other tests are typically done to confirm the diagnosis. Tests to diagnose an arteriovenous fistula can include:

  • Duplex ultrasound. Duplex ultrasound is the most effective and common way to check for an arteriovenous fistula in the legs or arms. In duplex ultrasound, sound waves are used to evaluate the speed of blood flow.
  • Computerized tomography (CT) angiogram. This imaging test can show if blood flow is bypassing the capillaries. Dye (contrast) is given by IV for this test. The dye helps blood vessels show up more clearly on the images.
  • Magnetic resonance angiography (MRA). This test may be done if you have signs of an arteriovenous fistula deep under the skin. Like an MRI, an magnetic resonance angiography (MRA) uses a magnetic field and radio waves to create pictures of the body's soft tissues. Dye (contrast) is given by IV to help blood vessels show up better on the images.

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  • CT scan

  • Ultrasound


If an arteriovenous fistula is small and doesn't cause any other health problems, close monitoring by a health care provider may be the only treatment needed. Some small arteriovenous fistulas close by themselves without treatment.

If an arteriovenous fistula requires treatment, your provider may recommend:

  • Ultrasound-guided compression. This may be an option for an arteriovenous fistula in the legs that's easily seen on ultrasound. In this treatment, an ultrasound probe is push down on the fistula for about 10 minutes. The compression destroys blood flow to the damaged blood vessels.
  • Catheter embolization. In this procedure, a thin, flexible tube (catheter) is inserted in an artery near the arteriovenous fistula. Then, a small coil or stent is placed at the site of the fistula to reroute blood flow. Many people who have catheter embolization stay in the hospital for less than a day and can resume daily activities within a week.
  • Surgery. Large arteriovenous fistulas that can't be treated with catheter embolization may require surgery. The type of surgery needed depends on the size and location of the arteriovenous fistula.

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Preparing for your appointment

If you think you may have an arteriovenous fistula, make an appointment with your primary care provider. You may be referred to a doctor trained in blood vessel (vascular) or heart (cardiologist) diseases.

Appointments can be brief. Because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your provider.

What you can do

  • Write down any symptoms you're having, including any that may seem unrelated to an arteriovenous fistula.
  • Write down key personal information, including previous piercing injuries or a family history of arteriovenous fistulas or other blood vessel diseases.
  • Make a list of all medications, vitamins or supplements that you're taking. Include their doses.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to recall all the information provided to you during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Write down questions to ask your health care provider.

For an arteriovenous fistula, some basic questions to ask include:

  • What's the most likely cause of my symptoms?
  • Are there any other possible causes for my symptoms?
  • What kinds of tests will I need?
  • What treatments are available, and which do you recommend?
  • What's an appropriate level of physical activity?
  • I have other health conditions. How can I best manage these conditions together?
  • Should my children or other biological relatives be screened for this condition?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your doctor

Your health care provider is likely to ask you many questions. Being ready to answer them may save time to go over any details you want to spend more time on. Your provider may ask:

  • When did you first begin having symptoms?
  • Do you always have symptoms, or do they come and go?
  • How severe are the symptoms?
  • Does anything seem to improve the symptoms?
  • What, if anything, makes symptoms worse?
Arteriovenous fistula: An irregular blood vessel connection-Arteriovenous fistula - Diagnosis & treatment - Mayo Clinic (2024)


Is arteriovenous fistula serious? ›

The most serious problem associated with AVFs is that they transfer high-pressure arterial blood into the veins or venous sinuses that drain blood from the brain or spinal cord. This results in an increase in the pressure of the venous system around the brain or spinal cord.

Is AV fistula a major surgery? ›

AV fistula surgery takes a few hours and is generally an outpatient procedure. It can be done under general anesthesia or through a numbing of the arm.

What is the survival rate of arteriovenous fistula? ›

Previous studies reported a wide range of AVF survival rates: 68% to 92% for one-year survival, 57% to 85% for two-year survival, and 4% to 71% for five-year survival.

Is fistula a serious problem? ›

Fistulas can cause a lot of discomfort, and if left untreated, may cause serious complications. Some fistulas can cause a bacteria infection, which may result in sepsis, a dangerous condition that can lead to low blood pressure, organ damage or even death.

What is the most common cause of an arteriovenous fistula? ›

Arteriovenous fistulas may be present at birth (congenital) or they may occur later in life (acquired). Causes of arteriovenous fistulas include: Injuries that pierce the skin. An arteriovenous fistula may result from a gunshot or stab wound that occurs on a part of the body where a vein and artery are side by side.

How long can you have an AV fistula? ›

Many people are curious as to how long an AV fistula can last — for four DaVita patients, the answer is 35 years.

How painful is AV fistula surgery? ›

How is the AV fistula procedure performed? A surgeon usually performs the procedure in the operating room. You receive a local anesthetic (numbing medicine) at the proposed site along with IV sedation to relax you. Discomfort is minimal and you may even fall asleep during the 1 to 2 hour-long procedure.

Why do fistulas get so big? ›

Over time, your fistula should get larger, extending past the lines drawn on your arm when your access was created. This allows more blood to flow through the fistula and into the vein in order to provide a high enough blood flow rate during your hemodialysis treatments.

What is the most common complication of fistula? ›

The most important complications of fistulae for HD are lymphedema, infection, aneurysm, stenosis, congestive heart failure, steal syndrome, ischemic neuropathy and thrombosis.

What happens if a fistula bursts? ›

A vascular access—graft or fistula—connects a vein and an artery, so if it starts to bleed, there is a lot of pressure and it can lose far more blood in a short time than with just a cut. An access rupture is a medical emergency, and you must act quickly.

What does a fistula look like in the arm? ›

Larger AV fistulas may cause: Swelling along with a reddish appearance on the skin surface. Purplish, bulging veins that you can see through your skin, similar to varicose veins. Swelling in the arms or legs.

Can an AV fistula burst? ›

Blood loss due to infections of AV fistulas results from vessel wall weakening leading to aneurysm formation and rupture. Preexisting aneurysms can rupture secondary to superimposed infections. Surgical debridement of localized infections can also result in significant blood loss.

What should you not do with a fistula? ›

If you can't feel it you must contact your unit or renal ward the same day. Do not let anything obstruct the blood flow in your arm– do not allow your blood pressure to be taken on your fistula arm and do not wear constricting clothes or jewellery.

Is fistula 100% curable? ›

In simple low transsphincteric fistulas, the patient's selection is crucial in order to perform a safe fistulotomy or another sphincter-saving technique. The healing rate in simple anal fistulas is higher than 95% with low recurrence and without significant postoperative complications.

Can a fistula go away without surgery? ›

Treatment with fibrin glue is currently the only non-surgical option for anal fistulas. It involves the surgeon injecting glue into the fistula while you're under a general anaesthetic. The glue helps seal the fistula and encourages it to heal.

Is it OK to live with fistula? ›

While rarely life-threatening, fistulas can decrease people's quality of life and often need combined medical and surgical treatment. This information sheet provides some general information about fistulas and likely treatments. It also includes tips and suggestions which may help you if you are living with a fistula.

Is AV fistula surgery risky? ›

Infection, although rare, is another complication associated with AV Fistula. Therefore, all the patients are required to take care of the wound after the surgery is complete. Blood clotting can occur if the blood flow in the fistula stops. In this case, the surgeon will create a different type of access.

How serious is a fistula for dialysis? ›

It's also extremely common for people with kidney disease or kidney failure to have an arteriovenous fistula created surgically, as fistulas can be very helpful for people who need regular dialysis. However, they can cause serious complications or even death in rare cases.

Why would a patient need an AV fistula? ›

Dialysis fistula creation is a commonly performed procedure for patients who suffer from the end-stage renal disease who require permanent vascular access for hemodialysis. Arteriovenous fistulas are the preferred initial access compared to prosthetic grafts or hemodialysis catheters.

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