Hi! I am in CKD stage 5 and my last GFR was 13. Other than anemia, which I’ve been getting EPO injections and IV Iron for the past 1.5 years, and metabolic acidosis, I feel okay. My other electrolytes have been in the normal range so far. I am scheduled to get a Brachial Basilic fistula in my upper left arm in 3 weeks and I am very nervous about it. I had my veins mapped a month ago then meet with a vascular surgeon last week. He said the veins in my forearms and my cephalic vein (in both arms) are too small to use. My left arm is my non-dominant arm. He said the success rate for the fistula is 60-80%. He said this will be two separate surgeries. The first one is in 3 weeks to connect the brachial artery to the basilic vein. The second surgery will be 6-8 weeks later to transpose (move over and lift up) the basilic vein. I’ve done tons of reading about everything CKD, ESRD, fistula & dialysis in the last six months since my nephrologist told me I would likely need dialysis within the next year. I expressed to the surgeon that I want an experienced surgeon and did not want a resident to do the surgery. He told me it is a teaching hospital and the residents do surgery. He basically told me that’s how things are done and I don’t have a choice. I read that you should have an experienced vascular surgeon, who has done at least 25 fistula surgeries, to perform the surgery. I would have been a little worried anyway, but knowing they scheduled a resident to do my surgery has me very worried. Anyone have any words of wisdom for me?
Need reassurance for upcoming fistula surgery - Kidney Disease
Need reassurance for upcoming fistula surgery
Just because there is a resident does not mean the regular surgeon won't be on board. I go to a teaching medical center and they always have residents on board for everything. My fistula surgery had a team of a residents not only for the surgery, but anesthesiologist, and other ones. There were eight people in the room, not counting nurses, and it took 2.5 hours. But it has been fantastic. BTW, I was told it was going to be two surgeries, and it ended up with only one. Works great.
Thanks for your reply. I’m glad your surgery turned out well and your fistula is working great. I feel a little better hearing your success story. He did say there would be an experienced surgeon in the room. It only takes a second to make a mistake, but I guess it won’t do me any good to worry. I wonder why they decided to do one surgery for you instead of two. He told me they wait to do the second surgery in 6-8 weeks to be sure the fistula matures . Seems like it would be easier to move the vein over before it gets larger.
Can you get a second opinion somewhere else? Doesn’t look like you are in an immediate rush.
I did PD not HD. But if you are uncomfortable for any reason, speak up. See if you can meet both the resident and the surgeon beforehand to calm any nerves. Always advocate for yourself.
Also want to wish you luck and sending you lots of positive energy.
Thanks for the well wishes and positive energy. I have a pre-op appointment a week before the surgery, so I’ll ask more questions and ask to meet them.
it’s your body. Your insurance doesn’t cover any other hospital ?
Yes it does, but I trust the hospital I’m going to more than the other one,
On the other hand, as procedures go, this one is fairly easy for a vascular surgeon. If he/she is handing the reins over to a resident, it's probably because they trust that resident to be competent. I'm sure that there is an experienced surgeon in the wings, just in case.
Just like Basetmommer, I was told I'd need two surgeries. It only took one. I have an brachial too in my upper left arm. It just matured and floated up on it's own. No second operation needed. I too was upset when I learned a resident created my ostomy. It worked out ok and the experienced surgeon was over his shoulder the whole time.
I didn’t know it could float up like that. Maybe I’ll only need one surgery like you and Bassetmommer.
After 2+ years mine is pretty prominent now. Luckily I haven't had to use mine. My eGFR was steadily falling and all the Dr. expected I'd be on dialysis 2 years ago. Instead my eGFR has slowly climbed. I'm at 31 now. I'm unusual, my CKD is from long time dehydration from a high output ileostomy. Look at this crazy graph! What a story.
That’s great that your gfr went up and you have been able to put off dialysis. Bet that doesn’t happen to people very much!
Yeah. Since my CKD is from dehydration getting that under control and losing 50 pounds helped. Less work on kidney because there is less of me.
Hi I had my fistula done in Jan this year, local anneasthetic and it was a lot better than I thought, the surgeon talked to me all the time along with another guy reassuring me. A bit later was told I my need a vein widening with a balloon procedure, I was at 5 efgr and ended up having to start emergency dialysis and my veins were ok. I have had 2 sessions and going today. it was worse thinking about it all previously and I feel so much better than I did. best wishes.
Sorry to hear you needed emergency dialysis. I’m glad your fistula worked ok for you. Like you said, it will probably be much better than I am thinking. I wish you all the best and glad to hear you feel much better.
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