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Arteriovenous fistula creation for hemodialysis and its complications

Author
Karen Woo, MD
Section Editors
Jeffrey S Berns, MD
David L Cull, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Two types of permanent vascular access are available for hemodialysis, the arteriovenous (AV) fistula and the AV graft. Of these, the AV fistula 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, is associated with the lowest incidence of morbidity and mortality [1-5].

The creation of native AV fistulas for hemodialysis and their complications are reviewed here. An overview of the different types of chronic hemodialysis access is presented separately. (See "Overview of chronic hemodialysis vascular access".)

GENERAL CHARACTERISTICS

Benefits and features — Arteriovenous (AV) fistulas are generally preferred over AV grafts. However, the temptation to create an AV fistula to satisfy the fistula-first initiative in patients with inadequate vessels should be resisted. Overly aggressive attempts to increase AV fistula prevalence in patients with suboptimal anatomy leads to reduced maturation rates and a longer duration of dialysis catheter use [6]. (See "Patient evaluation and vascular mapping prior to placement of hemodialysis arteriovenous access", section on 'Ideal type of hemodialysis AV access'.)

The benefits of AV fistulas over other forms of chronic access are discussed in detail elsewhere. (See "Overview of chronic hemodialysis vascular access".)

All types of AV fistulas possess similar characteristics. These include the following (see 'Types by anatomic location' below):

                                
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Literature review current through: Sep 2017. | This topic last updated: Sep 15, 2017.
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