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Primary failure of the hemodialysis arteriovenous fistula

Gerald A Beathard, MD, PhD
Section Editors
David L Cull, MD
Jeffrey S Berns, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


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 "Patient evaluation and vascular mapping prior to placement of hemodialysis arteriovenous access", section on 'Goals for AV access creation' and "Overview of chronic hemodialysis vascular access".)

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 AV fistulas is reviewed here. Failure of the mature AV fistula and other complications of AV fistulas, 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 arteriovenous hemodialysis access".)


Once an arteriovenous (AV) fistula is created, it must develop to the point that it is adequate in size and depth, allowing repeated successful cannulation, and can provide adequate blood flow to support the hemodialysis prescription. Whether an AV fistula will mature without additional intervention is generally apparent at four to six weeks following creation [1,2]. Early fistula evaluation enables identification of areas of stenosis in nonmaturing fistulas, which can then be safely and effectively treated with appropriate intervention. In many cases, a detailed physical examination of the access will point to the cause of the arrested maturation [3-5]. If an abnormality is detected, further evaluation of the AV fistula should be accomplished as soon as possible, usually with duplex ultrasound [5] or angiography [6,7]. (See "Maturation and evaluation of the newly created hemodialysis arteriovenous fistula".)


We define primary failure as an arteriovenous (AV) fistula that has never been 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 2017. | This topic last updated: Nov 29, 2017.
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