Access to circulation by permanent arteriovenous fistula in regular dialysis treatment.

Blood Access for Haemodialysis

“…Unpolished and untreated steel needles lead to fibrin formation and clotting in the outflow tract [7,12], and whilst Teflon is in itself acceptable, the tech nique of introduction of Teflon needles tends to tear the vein wall and self puncture is more difficult. Highly polished, presiliconised stainless steel needles are now readily available and have eliminated most difficulties [7,22], A short needle with a bevel where the tip is not razor-sharp, but with cutting edges [23] produces less trauma and leakage than those with a sharp tip.…”

“…In addition to this the complications and morbidity were considerable: haemorrhage, infec tion, clotting, poor function on dialysis, poor patient acceptability and psychological fixation. Shunt complications were considered to be the greatest cause of morbidity [3,12] in chronic dialysis patients necessitating costly and inconveniently long periods of hospitalisation [5,7]. A major factor in this respect was the excessive demand on medical staff required to deal with these complications [7], It has been calculated that in an 80 to 100-patient unit one doctor and nurse could have been continuously employed dealing with shunts and their complications alone.…”

“…This factor, however, may reflect the change in most centres to arteriovenous fistulae (A-V fistulae) and elective functioning shunt removal. Individual shunt-life varied from 2 months [12] to 6 years [2], and in centres with poor survivals, repeated oper ations meant the progressive destruction of the vasculature. In addition to this the complications and morbidity were considerable: haemorrhage, infec tion, clotting, poor function on dialysis, poor patient acceptability and psychological fixation.…”

The endless history of vascular access: a surgeon's perspective

“…However, the end vein-to side of artery anastomosis was more widely performed, probably due to the moot hypothesis of a more simple technique, and due to the fact that the blood flux in the radial artery distal to the anastomosis could remain unchanged in the case of thrombosis. Alternative sites were adopted in the following years for constructing direct anastomosis between the arterial and venous system, as the "snuff box" fistula (17), the ulnar-basilic fistula (18) or the radiocephalic fistula in the mid-forearm (19). In some situations precluding a more distal AVF, proximal AVFs were constructed at the antecubital fossa into an end vein-to-side artery (20) or, even better, in a side-to-side fashion, between the brachial artery and an antecubital vein.…”

Plethysmographic Forearm Blood Flow Studies in Maintenance Hemodialysis Patients with Radial Arteriovenous Fistulae

“…In over 20 patients and after up to 40 months no fistula has closed once it began to function properly. The AVF is now in use in many centers worldwide [5,6].…”