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Creating an arteriovenous fistula for hemodialysis

Gerald A Beathard, MD, PhD
Section Editors
Jeffrey S Berns, MD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


The three principal forms of chronic vascular access for hemodialysis are native arteriovenous fistulas (native AVFs), arteriovenous shunts using graft material (AV graft), and tunnelled double-lumen catheters. Of these, the native AVF is preferred for long-term hemodialysis vascular access since it has the best long-term primary patency rate, requires the fewest interventions of any type of access, and most importantly, AVFs are associated with the lowest incidence of morbidity and mortality [1-5]. The National Kidney Foundation Kidney Disease Quality Outcomes Initiative (NKF-KDOQI) clinical practice guidelines suggest a goal prevalence rate for native AVF of 65 percent [6]. To achieve these goals, disparities in the successful creation of native AVF need to be overcome. In most studies, fewer AV fistulas are reported in female than in male hemodialysis patients [7-11], and in African-American compared with non-African-American hemodialysis patients [7-12]. The explanation for gender and racial differences is not totally clear; however, it has been shown that there is a greater risk of primary failure in both women and African Americans [13,14].

The creation of native AVFs for hemodialysis patients is reviewed here. An overview of the different types of chronic hemodialysis access is presented separately. (See "Overview of chronic hemodialysis vascular access".)


Benefits — Native arteriovenous fistulas (AVFs) are preferred over other forms of chronic hemodialysis access and we recommend placement of an AVF rather than an AV graft or tunnelled double-lumen central catheter, whenever possible. However, the temptation to create an arteriovenous fistula to satisfy the fistula-first initiative in patients with inadequate vessels should be resisted. Overly aggressive attempts to increase AVF prevalence in patients with suboptimal anatomy leads to reduced maturation rates, and a longer duration of dialysis catheter use [15]. (See 'Patients with inadequate vessels' below.)

The benefits of AVFs over other forms of chronic access are summarized below and discussed in detail elsewhere. (See "Overview of chronic hemodialysis vascular access", section on 'Comparison of AV fistulas and AV grafts'.)

AVFs are associated with decreased morbidity and mortality among hemodialysis patients compared with AV grafts and central venous catheters [16-18].


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  1. Feldman HI, Kobrin S, Wasserstein A. Hemodialysis vascular access morbidity. J Am Soc Nephrol 1996; 7:523.
  2. Ascher E, Gade P, Hingorani A, et al. Changes in the practice of angioaccess surgery: impact of dialysis outcome and quality initiative recommendations. J Vasc Surg 2000; 31:84.
  3. Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int 2002; 62:1109.
  4. Dixon BS, Novak L, Fangman J. Hemodialysis vascular access survival: upper-arm native arteriovenous fistula. Am J Kidney Dis 2002; 39:92.
  5. Añel RL, Yevzlin AS, Ivanovich P. Vascular access and patient outcomes in hemodialysis: questions answered in recent literature. Artif Organs 2003; 27:237.
  6. NKF-K/DOQI Clinical Practice Guidelines For Vascular Access: Update 2006. Guideline 8: Clinical outcome goals, 8.1 goals for access placement, 8.1.2 prevalent functional AVF placement rate.
  7. Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 2002; 35:603.
  8. Miller CD, Robbin ML, Allon M. Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Kidney Int 2003; 63:346.
  9. Hirth RA, Turenne MN, Woods JD, et al. Predictors of type of vascular access in hemodialysis patients. JAMA 1996; 276:1303.
  10. Ifudu O, Macey LJ, Homel P, et al. Determinants of type of initial hemodialysis vascular access. Am J Nephrol 1997; 17:425.
  11. Allon M, Ornt DB, Schwab SJ, et al. Factors associated with the prevalence of arteriovenous fistulas in hemodialysis patients in the HEMO study. Hemodialysis (HEMO) Study Group. Kidney Int 2000; 58:2178.
  12. Astor BC, Coresh J, Powe NR, et al. Relation between gender and vascular access complications in hemodialysis patients. Am J Kidney Dis 2000; 36:1126.
  13. Peterson WJ, Barker J, Allon M. Disparities in fistula maturation persist despite preoperative vascular mapping. Clin J Am Soc Nephrol 2008; 3:437.
  14. Lok CE, Allon M, Moist L, et al. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol 2006; 17:3204.
  15. Patel ST, Hughes J, Mills JL Sr. Failure of arteriovenous fistula maturation: an unintended consequence of exceeding dialysis outcome quality Initiative guidelines for hemodialysis access. J Vasc Surg 2003; 38:439.
  16. Dhingra RK, Young EW, Hulbert-Shearon TE, et al. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int 2001; 60:1443.
  17. Woods JD, Port FK. The impact of vascular access for haemodialysis on patient morbidity and mortality. Nephrol Dial Transplant 1997; 12:657.
  18. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol 2004; 15:477.
  19. Perera GB, Mueller MP, Kubaska SM, et al. Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Ann Vasc Surg 2004; 18:66.
  20. Fitzgerald JT, Schanzer A, McVicar JP, et al. Upper arm arteriovenous fistula versus forearm looped arteriovenous graft for hemodialysis access: a comparative analysis. Ann Vasc Surg 2005; 19:843.
  21. Keuter XH, De Smet AA, Kessels AG, et al. A randomized multicenter study of the outcome of brachial-basilic arteriovenous fistula and prosthetic brachial-antecubital forearm loop as vascular access for hemodialysis. J Vasc Surg 2008; 47:395.
  22. Pisoni RL, Young EW, Dykstra DM, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 2002; 61:305.
  23. Huber TS, Carter JW, Carter RL, Seeger JM. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review. J Vasc Surg 2003; 38:1005.
  24. Lee T, Barker J, Allon M. Comparison of survival of upper arm arteriovenous fistulas and grafts after failed forearm fistula. J Am Soc Nephrol 2007; 18:1936.
  25. Oliver MJ, McCann RL, Indridason OS, et al. Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas. Kidney Int 2001; 60:1532.
  26. Tordoir JH, Rooyens P, Dammers R, et al. Prospective evaluation of failure modes in autogenous radiocephalic wrist access for haemodialysis. Nephrol Dial Transplant 2003; 18:378.
  27. Robbin ML, Chamberlain NE, Lockhart ME, et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology 2002; 225:59.
  28. Valentine RJ, Bouch CW, Scott DJ, et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J Vasc Surg 2002; 36:351.
  29. NKF-K/DOQI Clinical Practice Guidelines For Vascular Access: Update 2006. Guideline 2: Selection and placement of hemodialysis access, 2.1 the order of preference for placement of fistulae, 2.1.1 preferred: fistulae.
  30. Sidawy AN, Spergel LM, Besarab A, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48:2S.
  31. Tordoir JH, Dammers R, van der Sande FM. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg 2004; 27:1.
  32. van Hoek F, Scheltinga MR, Kouwenberg I, et al. Steal in hemodialysis patients depends on type of vascular access. Eur J Vasc Endovasc Surg 2006; 32:710.
  33. Jennings WC. Creating arteriovenous fistulas in 132 consecutive patients: exploiting the proximal radial artery arteriovenous fistula: reliable, safe, and simple forearm and upper arm hemodialysis access. Arch Surg 2006; 141:27.
  34. Bonforte G, Rossi E, Auricchio S, et al. The middle-arm fistula as a valuable surgical approach in patients with end-stage renal disease. J Vasc Surg 2010; 52:1551.
  35. Bonforte G, Zerbi S, Surian M. The middle-arm fistula: A new native arteriovenous vascular access for hemodialysis patients. Ann Vasc Surg 2004; 18:448.
  36. Jennings WC, Turman MA, Taubman KE. Arteriovenous fistulas for hemodialysis access in children and adolescents using the proximal radial artery inflow site. J Pediatr Surg 2009; 44:1377.
  37. Jennings WC, Landis L, Taubman KE, Parker DE. Creating functional autogenous vascular access in older patients. J Vasc Surg 2011; 53:713.
  38. Chemla ES, Morsy MA. Is basilic vein transposition a real alternative to an arteriovenous bypass graft? A prospective study. Semin Dial 2008; 21:352.
  39. Coburn MC, Carney WI Jr. Comparison of basilic vein and polytetrafluoroethylene for brachial arteriovenous fistula. J Vasc Surg 1994; 20:896.
  40. Schild AF, Perez E, Gillaspie E, et al. Arteriovenous fistulae vs. arteriovenous grafts: a retrospective review of 1,700 consecutive vascular access cases. J Vasc Access 2008; 9:231.
  41. Snyder DC, Clericuzio CP, Stringer A, May W. Comparison of outcomes of arteriovenous grafts and fistulas at a single Veterans' Affairs medical center. Am J Surg 2008; 196:641.
  42. Dalman RL, Harris EJ Jr, Victor BJ, Coogan SM. Transition to all-autogenous hemodialysis access: the role of preoperative vein mapping. Ann Vasc Surg 2002; 16:624.
  43. Bourquelot P, Tawakol JB, Gaudric J, et al. Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis. J Vasc Surg 2009; 50:369.
  44. Krochmal DJ, Rebecca AM, Kalkbrenner KA, et al. Superficialization of deep arteriovenous access procedures in obese patients using suction-assisted lipectomy: A novel approach. Can J Plast Surg 2010; 18:25.
  45. Pisoni RL, Young EW, Mapes DL, et al. Vascular access use and outcomes in the U.S., Europe, and Japan: results from the Dialysis Outcomes and Practice Patterns Study. Nephrol News Issues 2003; 17:38.
  46. Lee T, Barker J, Allon M. Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes. Am J Kidney Dis 2005; 46:501.
  47. Rayner HC, Besarab A, Brown WW, et al. Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. Am J Kidney Dis 2004; 44:22.
  48. Friedman AL, Walworth C, Meehan C, et al. First hemodialysis access selection varies with patient acuity. Adv Ren Replace Ther 2000; 7:S4.
  49. Astor BC, Eustace JA, Powe NR, et al. Timing of nephrologist referral and arteriovenous access use: the CHOICE Study. Am J Kidney Dis 2001; 38:494.
  50. Lee T, Barker J, Allon M. Associations with predialysis vascular access management. Am J Kidney Dis 2004; 43:1008.
  51. O'Hare AM, Allon M, Kaufman JS. Whether and when to refer patients for predialysis AV fistula creation: complex decision making in the face of uncertainty. Semin Dial 2010; 23:452.
  52. Oliver MJ, Rothwell DM, Fung K, et al. Late creation of vascular access for hemodialysis and increased risk of sepsis. J Am Soc Nephrol 2004; 15:1936.
  53. NKF-K/DOQI Clinical Practice Guidelines For Vascular Access: Update 2006. Guideline 1: Patient preparation for permanent hemodialysis access, 1.3 Patients should have a functional permanent access, 1.3.1 A fistula should be placed at least 6 months before the anticipated start of HD treatments.
  54. NKF-K/DOQI Clinical Practice Guidelines For Vascular Access: Update 2006. Guideline 1: Patient preparation for permanent hemodialysis access, 1.4 History and physical examination.
  55. Beathard, GA. Complications of vascular access. In: Complications of Dialysis - Recognition and Management. Edited by Lameire, N and Mehta, R. Marcel Dekker, Inc, New York 2000. p. 1.
  56. Papasavas PK, Reifsnyder T, Birdas TJ, et al. Prediction of arteriovenous access steal syndrome utilizing digital pressure measurements. Vasc Endovascular Surg 2003; 37:179.
  57. Morsy AH, Kulbaski M, Chen C, et al. Incidence and characteristics of patients with hand ischemia after a hemodialysis access procedure. J Surg Res 1998; 74:8.
  58. Silva MB Jr, Hobson RW 2nd, Pappas PJ, et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg 1998; 27:302.
  59. Agrifoglio M, Dainese L, Pasotti S, et al. Preoperative assessment of the radial artery for coronary artery bypass grafting: is the clinical Allen test adequate? Ann Thorac Surg 2005; 79:570.
  60. Hirai M, Kawai S. False positive and negative results in Allen test. J Cardiovasc Surg (Torino) 1980; 21:353.
  61. Kamienski RW, Barnes RW. Critique of the Allen test for continuity of the palmar arch assessed by doppler ultrasound. Surg Gynecol Obstet 1976; 142:861.
  62. Ruland O, Borkenhagen N, Prien T. [The Doppler palm test]. Ultraschall Med 1988; 9:63.
  63. Paul, BZ, Feeney, CM. Combining the modified Allen's Test and pulse oximetry for evaluating ulnar collateral circulation to the hand for radial artery catheterization of the ED patient. The California Journal of Emergency Medicine 2003; 4:89.
  64. Georgiadis GS, Charalampidis DG, Argyriou C, et al. The Necessity for Routine Pre-operative Ultrasound Mapping Before Arteriovenous Fistula Creation: A Meta-analysis. Eur J Vasc Endovasc Surg 2015; 49:600.
  65. Ferring M, Claridge M, Smith SA, Wilmink T. Routine preoperative vascular ultrasound improves patency and use of arteriovenous fistulas for hemodialysis: a randomized trial. Clin J Am Soc Nephrol 2010; 5:2236.
  66. Wong V, Ward R, Taylor J, et al. Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg 1996; 12:207.
  67. Malovrh M. Native arteriovenous fistula: preoperative evaluation. Am J Kidney Dis 2002; 39:1218.
  68. Ferring M, Henderson J, Wilmink A, Smith S. Vascular ultrasound for the pre-operative evaluation prior to arteriovenous fistula formation for haemodialysis: review of the evidence. Nephrol Dial Transplant 2008; 23:1809.
  69. Jennings WC, Kindred MG, Broughan TA. Creating radiocephalic arteriovenous fistulas: technical and functional success. J Am Coll Surg 2009; 208:419.
  70. Bonforte G, Zerbi S, Pasi A, et al. Distal arteriovenous fistulas in elderly hemodialysis patients. J Vasc Access 2000; 1:144.
  71. Fadrowski JJ, Hwang W, Frankenfield DL, et al. Clinical course associated with vascular access type in a national cohort of adolescents who receive hemodialysis: findings from the Clinical Performance Measures and US Renal Data System projects. Clin J Am Soc Nephrol 2006; 1:987.
  72. Leonard MB, Donaldson LA, Ho M, Geary DF. A prospective cohort study of incident maintenance dialysis in children: an NAPRTC study. Kidney Int 2003; 63:744.
  73. Bourquelot P, Raynaud F, Pirozzi N. Microsurgery in children for creation of arteriovenous fistulas in renal and non-renal diseases. Ther Apher Dial 2003; 7:498.
  74. He C, Charoenkul V, Kahn T, et al. Impact of the surgeon on the prevalence of arteriovenous fistulas. ASAIO J 2002; 48:39.
  75. Basile C, Lomonte C. The operating surgeon is the major determinant for a successful arteriovenous fistula maturation. Kidney Int 2007; 72:772.
  76. Fassiadis N, Morsy M, Siva M, et al. Does the surgeon's experience impact on radiocephalic fistula patency rates? Semin Dial 2007; 20:455.
  77. Raynaud A, Novelli L, Bourquelot P, et al. Low-flow maturation failure of distal accesses: Treatment by angioplasty of forearm arteries. J Vasc Surg 2009; 49:995.
  78. Asif A, Leon C, Merrill D, et al. Arterial steal syndrome: a modest proposal for an old paradigm. Am J Kidney Dis 2006; 48:88.
  79. Robbin ML, Gallichio MH, Deierhoi MH, et al. US vascular mapping before hemodialysis access placement. Radiology 2000; 217:83.
  80. Elsharawy MA, Moghazy KM. Impact of pre-operative venography on the planning and outcome of vascular access for hemodialysis patients. J Vasc Access 2006; 7:123.
  81. Nursal TZ, Oguzkurt L, Tercan F, et al. Is routine preoperative ultrasonographic mapping for arteriovenous fistula creation necessary in patients with favorable physical examination findings? Results of a randomized controlled trial. World J Surg 2006; 30:1100.
  82. Wells AC, Fernando B, Butler A, et al. Selective use of ultrasonographic vascular mapping in the assessment of patients before haemodialysis access surgery. Br J Surg 2005; 92:1439.
  83. Allon M, Lockhart ME, Lilly RZ, et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 2001; 60:2013.
  84. Malovrh M. The role of sonography in the planning of arteriovenous fistulas for hemodialysis. Semin Dial 2003; 16:299.
  85. Mihmanli I, Besirli K, Kurugoglu S, et al. Cephalic vein and hemodialysis fistula: surgeon's observation versus color Doppler ultrasonographic findings. J Ultrasound Med 2001; 20:217.
  86. National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis 48:S1-S322, 2006 (suppl 1). http://www.kidney.org/professionals/kdoqi/pdf/12-50-0210_JAG_DCP_Guidelines-HD_Oct06_SectionA_ofC.pdf (Accessed on July 05, 2014).
  87. Wong CS, McNicholas N, Healy D, et al. A systematic review of preoperative duplex ultrasonography and arteriovenous fistula formation. J Vasc Surg 2013; 57:1129.
  88. Kim JT, Chang WH, Oh TY, Jeong YK. Venous distensibility as a key factor in the success of arteriovenous fistulas at the wrist. Ann Vasc Surg 2011; 25:1094.
  89. van der Linden J, Lameris TW, van den Meiracker AH, et al. Forearm venous distensibility predicts successful arteriovenous fistula. Am J Kidney Dis 2006; 47:1013.
  90. Asif A, Cherla G, Merrill D, et al. Venous mapping using venography and the risk of radiocontrast-induced nephropathy. Semin Dial 2005; 18:239.
  91. Kian K, Wyatt C, Schon D, et al. Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients. Kidney Int 2006; 69:1444.
  92. Lauvao LS, Ihnat DM, Goshima KR, et al. Vein diameter is the major predictor of fistula maturation. J Vasc Surg 2009; 49:1499.
  93. Salman L, Alex M, Unger SW, et al. Secondary autogenous arteriovenous fistulas in the "fistula first" era: results of a longterm prospective study. J Am Coll Surg 2009; 209:100.
  94. Beathard GA. Interventionalist's role in identifying candidates for secondary fistulas. Semin Dial 2004; 17:233.
  95. Asif A, Leon C, Merrill D, et al. Optimal timing for secondary arteriovenous fistula creation: devastating effects of delaying conversion. Semin Dial 2006; 19:425.
  96. Rus RR, Ponikvar R, Kenda RB, Buturović-Ponikvar J. Effect of local physical training on the forearm arteries and veins in patients with end-stage renal disease. Blood Purif 2003; 21:389.
  97. Rus RR, Ponikvar R, Kenda RB, Buturovic-Ponikvar J. Effect of intermittent compression of upper arm veins on forearm vessels in patients with end-stage renal disease. Hemodial Int 2005; 9:275.
  98. Farber A, Imrey PB, Huber TS, et al. Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study. J Vasc Surg 2016; 63:163.
  99. O'Hare AM, Dudley RA, Hynes DM, et al. Impact of surgeon and surgical center characteristics on choice of permanent vascular access. Kidney Int 2003; 64:681.
  100. Choi KL, Salman L, Krishnamurthy G, et al. Impact of surgeon selection on access placement and survival following preoperative mapping in the "Fistula First" era. Semin Dial 2008; 21:341.
  101. Kalantar-Zadeh K, Abbott KC, Salahudeen AK, et al. Survival advantages of obesity in dialysis patients. Am J Clin Nutr 2005; 81:543.
  102. Stolic R. Obesity in renal failure--health or disease? Med Hypotheses 2010; 75:497.
  103. Singh P, Robbin ML, Lockhart ME, Allon M. Clinically immature arteriovenous hemodialysis fistulas: effect of US on salvage. Radiology 2008; 246:299.
  104. Roberts C. Saving a brachiocephalic fistula using lipectomy. Nephrol Nurs J 2005; 32:331.
  105. Barnard KJ, Taubman KE, Jennings WC. Accessible autogenous vascular access for hemodialysis in obese individuals using lipectomy. Am J Surg 2010; 200:798.
  106. Chan MR, Young HN, Becker YT, Yevzlin AS. Obesity as a predictor of vascular access outcomes: analysis of the USRDS DMMS Wave II study. Semin Dial 2008; 21:274.
  107. Kats M, Hawxby AM, Barker J, Allon M. Impact of obesity on arteriovenous fistula outcomes in dialysis patients. Kidney Int 2007; 71:39.
  108. Plumb TJ, Adelson AB, Groggel GC, et al. Obesity and hemodialysis vascular access failure. Am J Kidney Dis 2007; 50:450.
  109. Park J, Ahmadi SF, Streja E, et al. Obesity paradox in end-stage kidney disease patients. Prog Cardiovasc Dis 2014; 56:415.
  110. Vachharajani TJ, Moossavi S, Jordan JR, et al. Re-evaluating the Fistula First Initiative in Octogenarians on Hemodialysis. Clin J Am Soc Nephrol 2011; 6:1663.
  111. Kurella M, Covinsky KE, Collins AJ, Chertow GM. Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med 2007; 146:177.
  112. Xue JL, Dahl D, Ebben JP, Collins AJ. The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients. Am J Kidney Dis 2003; 42:1013.
  113. DeSilva RN, Patibandla BK, Vin Y, et al. Fistula first is not always the best strategy for the elderly. J Am Soc Nephrol 2013; 24:1297.
  114. Richardson AI 2nd, Leake A, Schmieder GC, et al. Should fistulas really be first in the elderly patient? J Vasc Access 2009; 10:199.
  115. Lok CE, Oliver MJ, Su J, et al. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int 2005; 67:2462.
  116. Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007; 45:420.
  117. Weale AR, Bevis P, Neary WD, et al. Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly. J Vasc Surg 2008; 47:144.
  118. Puskar D, Pasini J, Savić I, et al. Survival of primary arteriovenous fistula in 463 patients on chronic hemodialysis. Croat Med J 2002; 43:306.
  119. Obialo CI, Tagoe AT, Martin PC, Asche-Crowe PE. Adequacy and survival of autogenous arteriovenous fistula in African American hemodialysis patients. ASAIO J 2003; 49:435.
  120. Huber TS, Ozaki CK, Flynn TC, et al. Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access. J Vasc Surg 2002; 36:452.
  121. Rayner HC, Pisoni RL, Gillespie BW, et al. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2003; 63:323.
  122. Marcus RJ, Marcus DA, Sureshkumar KK, et al. Gender differences in vascular access in hemodialysis patients in the United States: developing strategies for improving access outcome. Gend Med 2007; 4:193.
  123. de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 2009; 302:1782.
  124. Beigi AA, Sadeghi AM, Khosravi AR, et al. Effects of the arteriovenous fistula on pulmonary artery pressure and cardiac output in patients with chronic renal failure. J Vasc Access 2009; 10:160.
  125. Iwashima Y, Horio T, Takami Y, et al. Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF. Am J Kidney Dis 2002; 40:974.
  126. Yigla M, Abassi Z, Reisner SA, Nakhoul F. Pulmonary hypertension in hemodialysis patients: an unrecognized threat. Semin Dial 2006; 19:353.
  127. Korsheed S, Eldehni MT, John SG, et al. Effects of arteriovenous fistula formation on arterial stiffness and cardiovascular performance and function. Nephrol Dial Transplant 2011; 26:3296.
  128. Basile C, Lomonte C, Vernaglione L, et al. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant 2008; 23:282.
  129. Lazarides MK, Georgiadis GS, Tzilalis VD. Diabetes should not preclude efforts for creation of a primary radiocephalic fistula. Nephrol Dial Transplant 2002; 17:1852.
  130. Bonucchi D, Cappelli G, Albertazzi A. Which is the preferred vascular access in diabetic patients? A view from Europe. Nephrol Dial Transplant 2002; 17:20.
  131. Konner, K. Primary vascular access in diabetic patients: an audit. Nephrol Dial Transplant 2000; 15:317.
  132. Murphy GJ, Nicholson ML. Autogeneous elbow fistulas: the effect of diabetes mellitus on maturation, patency, and complication rates. Eur J Vasc Endovasc Surg 2002; 23:452.
  133. Field M, MacNamara K, Bailey G, et al. Primary patency rates of AV fistulas and the effect of patient variables. J Vasc Access 2008; 9:45.
  134. Lin SL, Huang CH, Chen HS, et al. Effects of age and diabetes on blood flow rate and primary outcome of newly created hemodialysis arteriovenous fistulas. Am J Nephrol 1998; 18:96.
  135. Sedlacek M, Teodorescu V, Falk A, et al. Hemodialysis access placement with preoperative noninvasive vascular mapping: comparison between patients with and without diabetes. Am J Kidney Dis 2001; 38:560.
  136. Fistula First. http://fistulafirst.org/LinkClick.aspx?fileticket=9R1VX2YjIWA%3d&tabid=117.
  137. Germain MJ, Cohen LM. Maintaining quality of life at the end of life in the end-stage renal disease population. Adv Chronic Kidney Dis 2008; 15:133.
  138. Drew DA, Lok CE, Cohen JT, et al. Vascular access choice in incident hemodialysis patients: a decision analysis. J Am Soc Nephrol 2015; 26:183.