Dialysis Fistula & Vascular Access in Johannesburg

What it involves

Dr Marais creates radiocephalic, brachiocephalic and brachiobasilic fistulas as anatomy allows. He also revises failing fistulas and places tunnelled dialysis catheters when a fistula is not yet mature or has failed.

The three fistula types follow the fistula-first hierarchy. A radiocephalic fistula at the wrist is preferred — it preserves proximal vessels for future use. A brachiocephalic fistula at the elbow is next. If neither is possible, a brachiobasilic fistula is created with a second-stage transposition to bring the deep vein to the surface.

Pre-operative vein mapping with ultrasound is standard. It identifies suitable veins (over 2.5 mm), documents inflow, and prevents wasted operations on inadequate anatomy. A failed fistula sets the patient back months.

Once created, a fistula needs six to twelve weeks to mature — the vein arterialises, dilates, and thickens. During this period, avoid blood pressures, drips, and blood samples on that arm. A monthly check confirms progression.

When it's indicated

As soon as a nephrologist identifies a patient heading towards dialysis. Fistulas need six to twelve weeks to mature before they can be used — early referral matters.

The approach

This is one of the quieter parts of the practice, referred by nephrologists rather than patients directly. It is also one of the most satisfying — a well-made fistula transforms years of dialysis life.

Recovery

Day-case procedure under regional or local anaesthesia in most cases. Some arm swelling for the first week is normal. Full dialysis use after six to twelve weeks depending on maturation.