title: Elbow AVF configurations and indications.
abstract: BACKGROUND
  Brescia-Cimino radiocephalic arteriovenous fistula (AVF) remains the first-choice vascular access procedure for patients in need of long-term hemodialysis. The average life expectancy of patients receiving hemodialysis has increased in recent years and many patients now live longer and require secondary or tertiary procedures. Elbow fistulas should only rarely be constructed as primary fistulas. The aim of the surgeon must be not only to achieve a functioning fistula, but to avoid possible complications other than failure to mature (FTM), like distal ischemia and cardiac failure and to save the vessels as much as possible for future procedures.
  
  
  BACKGROUND
  Both arterial and venous anatomy of the elbow and upper arm have significant variations. The surgeon must be aware of these variations during the operation, and try not to harm the vasculature of the extremity while trying to construct a functioning fistula. The main advantages of elbow fistulas are the opportunity to have multiple outflows, preservation of the major veins in their original place with no dissection and giving no harm to them, and having a longer outflow tract for cannulation.
  
  
  CONCLUSIONS
  In the elbow, beginning to construct an AVF with the perforating vein is the most advantageous. If the perforating vein is not available or has been used before, median cubital vein, its branches, median antecubital vein or other available nearby veins may be used depending on the anatomy. Perforating vein should be ligated if any other elbow vein is used to prevent flow to deep veins.
authors.affiliation: General Surgery Clinic, Istanbul Medical Faculty, Istanbul University, Istanbul - Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Baktiroglu
authors.affiliation: General Surgery Clinic, Istanbul Medical Faculty, Istanbul University, Istanbul - Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Yanar
authors.affiliation: General Surgery Clinic, Istanbul Medical Faculty, Istanbul University, Istanbul - Turkey.
authors.forename: Sercan
authors.initials: S
authors.lastname: Yuksel
authors.affiliation: General Surgery Clinic, Istanbul Medical Faculty, Istanbul University, Istanbul - Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Celik
authors.affiliation: General Surgery Clinic, Istanbul Medical Faculty, Istanbul University, Istanbul - Turkey.
authors.forename: Halime G
authors.initials: HG
authors.lastname: Kilic
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization; D004550:Elbow / Q000098:blood supply*; D005542:Forearm / Q000098:blood supply*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology; D008026:Ligation; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency