Trends in access surgery for hemodialysis.
Vascular access for chronic hemodialysis is for both doctors and nurses on one side and patients on the other a permanent, challenging problem. In respect to patency and complication rate, the direct AV fistula represents the most satisfactory solution and therefore should be achieved whenever feasible. In addition to the classic Brescia-Cimino and the brachiocephalic fistula, the most distal location in the snuff-box on one end and a transposed basilic vein at the upper arm on the other offer most satisfactory angioaccess alternatives that must be used stepwise from the periphery to more proximal sites. Graft fistulas should clearly be reserved for the patient for whom all autologous possibilities (with the exclusion of the autologous saphenous vein graft) have been used. Only ePTFE grafts have a patency rate comparable with direct autologous fistulas at a much higher cost.
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D000783:Aneurysm / Q000209:etiology; D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods / Q000639:trends; D001424:Bacterial Infections / Q000209:etiology; D002339:Carotid Arteries / Q000637:transplantation; D002408:Catheters, Indwelling; D002417:Cattle; D006801:Humans; D008875:Middle Aged; D006435:Renal Dialysis; D012501:Saphenous Vein / Q000637:transplantation; D013927:Thrombosis / Q000209:etiology; D014183:Transplantation, Heterologous; D014471:Umbilical Veins / Q000637:transplantation