Arteriovenous fistula patency

Figure 2.11 Patient had undergone a femoral peroneal bypass using a Dacron graft (large arrow) with a distal arteriovenous fistula (dAVF) constructed at the distal anastomosis. The peroneal artery (P) runoff is depicted by an arrow and smaller arrows point to the venous return via the fistula that removes the overload to the distal circulation, enabling improved graft patency.

Dardik H, Silvestri F, Alasio T, Berry S, Kahn M, Ibrahim I, et al. Improved method to create the common ostium variant of the distal arteriovenous fistula for enhancing crural prosthetic graft patency. J Vase Surg 1996 23 240-8. 

Dardik H. Update on the role of the distal arteriovenous fistula as an adjunct for improving graft patency and limb salvage rates following crural revascularization. Arm Vase Surg 2015 29 1022-28. 

Ferring M, Claridge M, Smith SA, Wilmink T Routine preoperative vascular ultrasound improves patency and use of arteriovenous fistulas for hemodialysis a randomized trial. Chn J Am Soc Nephrol 2010 5 2236-2244. Malovrh M Native arteriovenous fistula preoperative evaluation. Am J Kidney Dis 2002 39 1218-1225. 

Considerable morbidity exists when dealing with vascular access (VA) creation. Native arteriovenous fistulae (AVF) are the desired VA for patients on dialysis due to their comparably low morbidity and fairly good long-term patency. However, they are also at risk for nonmaturation, stenosis, thrombosis, infection, aneurysm formation, and steal syndrome [ 1 ]. Fistula success is dependent on the center of access creation. Hence, the vascular surgeon s skills and decisions are key [2]. Furthermore, success is also determined by preoperative, technical, and postoperative factors that will be discussed in this chapter (fig. 1). 

Smith GE, Gohil R, Chetter IC Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vase Surg 2012 55 849-855. 

Osborn G, Escofet X, Da Silva A Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts. Cochrane Database Syst Rev 2008 CD002786. 

Saran R, Elder SJ, Goodkin DA, Akiba T, Ethier J, Rayner HC, Saito A, Young EW, Gillespie BW, Merion RM, Pisoni RL Enhanced training in vascular access creation predicts arteriovenous fistula placement and patency in hemodialysis patients results from the Dialysis Outcomes and Practice Patterns Study. Ann Surg 2008 247 885-891. 

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