A ruptured or bleeding arteriovenous (AV) access in dialysis patients requires prompt surgical intervention. Learn about the procedure, risks, and recovery at Iswarya Hospital.

For patients on haemodialysis, a well-functioning arteriovenous (AV) access — either an AV fistula or AV graft — is a lifeline. It provides the repeated, high-flow vascular access needed for effective dialysis sessions. When an AV access ruptures or bleeds, prompt surgical intervention is essential to stop bleeding, protect the access, and ensure dialysis can continue.

What Is AV Access?

AV access is a surgically created connection between an artery and a vein in the arm (or less commonly, the leg) that allows blood to flow at the high rates required for haemodialysis. The two main types are:

AV Fistula: A direct surgical connection between an artery and vein — preferred because it is the patient's own tissue, long-lasting, and has fewer complications

AV Graft: A synthetic tube connecting artery and vein — used when natural vessels are insufficient for fistula creation

What Causes a Ruptured AV Access?

Common causes include:

Aneurysm (localised ballooning): Repeated needle insertions at the same site weaken the vessel wall over time

Trauma: Direct injury to the access site

Infection: Weakening and breakdown of the vessel wall

High pressure: Downstream stenosis (narrowing) causes upstream pressure buildup, leading to rupture

Thinning of overlying skin: After years of dialysis, skin over the access can thin and break down

Emergency Management

If AV access bleeds or ruptures:

Apply firm, continuous pressure immediately

Do not release pressure until medical help arrives

Call 044 2025 2025 — Iswarya Hospital's 24×7 emergency line

Do not remove the needle or clamp applied during dialysis

Surgical Repair: Sealing the Ruptured Access

Surgery is performed under local or regional anaesthesia, often as a day-case procedure:

Wound exploration: The surgeon exposes the ruptured area of the AV access

Bleeding control: The artery and vein are clamped to stop blood flow temporarily

Repair or ligation: The rupture is directly repaired (sutured) if the access is salvageable, or the damaged segment is ligated (tied off) and a new access is planned

Wound closure: The incision is closed in layers with a sterile dressing applied

If the AV fistula or graft cannot be saved, the surgeon discusses the next access options — including a new fistula in a different location or a temporary central venous catheter for dialysis continuity.

Recovery After AV Access Repair

Hospital stay: Usually same-day or overnight

Wound care: Keep the dressing clean and dry for 48 hours; attend dressing change appointments

Dialysis continuation: Depending on repair, dialysis may be temporarily performed via a central line until the repaired access heals and matures

Follow-up: Doppler ultrasound at 4–6 weeks to confirm patency (access is open and functioning)

Preventing Future Rupture

Rotate needle insertion sites with each dialysis session

Avoid repeated puncture of aneurysmal segments

Report any swelling, redness, or skin thinning over the access early

Attend regular access surveillance (Doppler ultrasound every 6–12 months)

At Iswarya Hospital, our nephrology and vascular surgery teams work together to manage dialysis access complications efficiently, ensuring minimal disruption to your dialysis schedule and long-term kidney care.

Simple Surgery to Seal Ruptured AV Access: What Dialysis Patients Need to Know