Chapter 1: Arteriovenous Fistulae (AVF)

There are several options for Renal Replacement Therapy (RRT) determined by patient factors, the access team skills and knowledge, geographic policies, and resources, to mention a few. A successful outcome is associated with lifelong planning and the appropriate access RRT is always chosen for each patient²³⁴. Therefore, no mode of dialysis, type and site of dialysis access should be considered superior, mandatory, or labeled ‘gold standard’. For example, peritoneal dialysis and hemodialysis must not be looked upon as competitive, but rather complementary, as several dialysis access types and devices may be needed over the patient’s lifetime, including renal transplantation.

This first chapter outlines basic principles for a native vein AVF. The wrist radio-cephalic anastomosis is described in detail as the surgical techniques are similar for different sites. Strict principles and meticulous practice of vascular surgical technique are paramount for success in arteriovenous fistulas as patients are high risk of uremia and renal failure associated with comorbidity. While failure of an AVF may not be limb threatening as in other areas of vascular surgery, the implications of a failed fistula may be wide reaching, particularly in younger patients adjusting to a lifetime of chronic disease.

These techniques are covered in detail with short videos illustrating anastomosis techniques. Recent endovascular innovations have developed two minimally invasive techniques to create AVF fistula using one or two catheter techniques respectively¹⁰¹¹¹². Using similar endovascular technique, the modified Seldinger peritoneal dialysis catheter placement similarly is a minimally invasive dialysis access (MIDA) procedure¹³. Preliminary reports claim near 100 % technical success and a maturation rate in the 80-90 % range. This evolving technology has the potential to expand dialysis to the very sick as general anesthesia is not needed. Its role and place in dialysis access will take place over the next few years^1011121314.