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Primary failure of the hemodialysis arteriovenous fistula

Author
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

INTRODUCTION

The goal of hemodialysis arteriovenous (AV) fistula creation is to achieve a functioning dialysis access (ie, one that can be cannulated repetitively and provide adequate flow for the dialysis treatment). (See "Creating an arteriovenous fistula for hemodialysis", section on 'AVF requirements for use' and "Patient evaluation and vascular mapping prior to placement of hemodialysis arteriovenous access", section on 'Goals for AV access creation'.)

Primary AV fistula failure, which we define as an AV fistula that is never usable, or fails within the first three months of its use, is a major problem; however, fistulas that fail to develop have a high incidence of correctable problems, and once these problems are addressed, a high success rate can be expected.

Primary failure of hemodialysis arteriovenous fistulas is reviewed here. Late failure of AV fistula and other complications of AV fistula, such as steal syndrome, aneurysm formation, infection, and excess flow leading to heart failure, are reviewed separately. (See "Failure of the mature hemodialysis arteriovenous fistula" and "Nonthrombotic complications of chronic hemodialysis arteriovenous vascular access".)

FISTULA MATURATION AND EVALUATION

Once a fistula is created, it must develop to the point that it is of adequate size and depth to allow successful repetitive cannulation, and that it can provide adequate blood flow to support the hemodialysis prescription. It is generally apparent at four to six weeks following creation whether an arteriovenous fistula will mature without additional intervention [1,2]. A detailed physical examination of the access will, in most instances, reveal the cause of the arrested maturation [3-5]. If an abnormality delaying maturation is detected at any point during examination and evaluation of a newly created arteriovenous (AV) fistula, further evaluation of the AV fistula should be accomplished as soon as possible, usually with duplex ultrasound [5] and/or angiography [6,7]. (See "Maturation and evaluation of the newly created hemodialysis arteriovenous fistula".)

PRIMARY FAILURE

We define primary failure as an arteriovenous (AV) fistula that is never usable for dialysis or that fails within three months of use [1,8]. The emphasis is generally on failure of maturation. The terms primary failure, early failure, and failure to mature are frequently heard and are essentially equivalent. We shall use the term primary failure.

                    

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Literature review current through: Nov 2016. | This topic last updated: Mon Jul 11 00:00:00 GMT 2016.
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