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Q: I’m starting dialysis, and my doctor told me I need to have an artereovenous fistula created. What does that mean?

You're not alone—many of the dialysis patients I see are confused about why they need a fistula. It comes down to the needles that are used during hemodialysis. They're much larger than the needles you usually see when you get a flu shot or have blood drawn. In fact, the vein in your arm isn't large enough for these needles, so we need to make it bigger. To create the fistula, a surgeon will connect the vein in your arm to an artery. The artery will then start pumping a higher volume of blood into the vein, increasing the pressure and causing the vein to expand and pop up under the skin slightly. This makes it possible for the needles to be inserted so that you can receive dialysis.

Most people find the fistula doesn't bother them at all, but in some cases they can get bigger over time or need to be changed after a few years. When that happens we can place another fistula in the other arm, or even in the legs.