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A Second Chance at Dialysis Access: Successful AV Fistula Salvage

By Dr. Ritesh Gaikwad – Vascular & Endovascular Surgeon, Thane & Mumbai

Background: A Story Many Dialysis Patients Can Relate To

A 57-year-old male patient undergoing maintenance hemodialysis for over 2.5 years was facing ongoing complications with dialysis access. After multiple failed AV fistula attempts on the left arm, he was dependent on a permacath, which led to recurring infections, fever, generalized weakness, and multiple hospital admissions.

He had previously been told that another AV fistula would not be possible.

The Turning Point: Reassessing Access Possibility

When he consulted me at Doctor Planet, Thane, I reevaluated his case and explained that he still had an 80% chance of successful fistula creation in the right forearm.

I successfully created a radio-cephalic AV fistula in his right arm. However, after 2 months, the fistula thrombosed due to an episode of low blood pressure.

First Salvage: Thrombolysis & Angioplasty

Instead of giving up and switching back to a catheter, I explained the options and opted for fistula salvage using:

• Intravenous thrombolysis to dissolve the clot
• Balloon angioplasty to dilate the vein and restore blood flow

This intervention successfully revived the fistula, and dialysis resumed through the same access site.

Second Salvage: Recurrent Flow Drop in Sept 2025

In September 2025, the patient again reported reduced flow through the fistula. A repeat evaluation was done, including:

• AV fistulography to assess the structure
• Balloon angioplasty to restore function

Again, the fistula was salvaged, and dialysis continued without needing a new central line or access procedure.

Key Takeaways

• AV fistula is the preferred access for long-term dialysis.
• Even after thrombosis or dysfunction, fistulas can often be salvaged.
• Catheters should be used only as a last resort due to infection risks.
• Timely evaluation by a vascular surgeon can prevent permanent access loss.

Experiencing Fistula Issues?

If you're on dialysis and have been told that a fistula isn’t possible—or that it’s too late to fix one—don’t give up.

Get a vascular surgeon’s opinion before giving up your lifeline.

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📍 KIMS Hospital, Ghodbunder Road, Thane. Doctor Planet, near Korum Mall.
📞 +91 96193 32942
🌐 www.drriteshgaikwad.com