AV Fistula Setup: The Vascular Case Everyone Should Know

If you’ve been around here a while, you know I love a good vascular case — even the smaller ones like an AV fistula setup.

It might not be as intense as a big bypass or endovascular repair, but arteriovenous fistulas are crucial procedures for dialysis access, and they show up often in both general and vascular specialties.

That means whether you’re deep into vascular or just rotating through general surgery, knowing how to set one up is a valuable skill. Here’s what you’ll typically need on your back table for an AV fistula case:

🛠 Instruments & Equipment:

• Clip appliers – automatic or manual

• Bulldogs – for temporary vessel occlusion

• Vascular clamps – essential for exposure and control

• Castro-Viejo needle drivers – for fine suture control

🧵 Sutures & Softs:

• Silk ties – typically 2-0, 3-0, and 4-0

• Suture boots – to keep sutures organized

• Vessel loops or umbilical tape – for identifying and controlling vessels

• #11 blade – for precise incisions

• 5-0 or 6-0 Prolene suture – usually with C-1 or BV-1 needles

• Olive tip/heparin flush needle – for delicate flushing of vessels

💉 Fluids & Extras:

• Heparinized injectable saline – in the bag, not the bottle

• Local anesthetic – based on surgeon preference

• Ultrasound gel – if Doppler or ultrasound guidance is used AV fistulas might look simple from the outside, but the precision required in handling vessels, managing flow, and setting up clean sutures makes them an excellent opportunity to refine your vascular skills.

Pro tip: Keep your softs organized, anticipate when to pass vascular clamps, and always double-check your heparin setup — nothing throws off a case like the wrong flush.