Abstract
Background With rising incidence and increased life expectancy of patients with chronic kidney
disease (CKD) and end-stage renal disease (ESRD), the number of patients requiring
hemodialysis has increased substantially. Vascular access is the lifeline for a patient
on hemodialysis (HD), and an arteriovenous fistula (AVF) is the undisputed gold standard
for HD access. An effective and long-lasting fistula serves to increase the life expectancy
of ESRD patients and improves their quality of life.
Learning Objectives This paper aims to give a comprehensive overview of AVF creation, including the various
techniques, patient selection, troubleshooting with decision-making, and common complications.
Authors share their experience from previous publications and over 2000 AVF surgeries.
They have not only described a new modification of the technique of proximal fistula
but have also established a direct correlation between bruit and thrill on operation
table and success of fistula surgery.
Conclusion A standardized, protocol-driven multidisciplinary approach with careful patient and
site selection, guided by outcome predictors, is vital in AVF surgery. Knowledge about
the potential complications of AVFs contributes to their timely detection and allows
measures to be taken that might prevent deleterious consequences that range from loss
of vascular access to serious morbidity and mortality.
Keywords
arteriovenous fistula - vascular access - guidelines - hemodialysis - chronic kidney
disease - ESRD
