Nephrol Dial Transplant (2000) 15: 145-147
© 2000 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
When insufficient arterial inflow becomes the Achilles heel of the av-fistula—what are the surgical approaches?
Medizinische Klinik I, Krankenhaus Köln-Merheim, Köln, Germany
Correspondence and offprint requests to: K. Konner, Schauins Land 24, D-51429 Bergisch Gladbach, Germany.
Historical notes
Generations of nephrologists and vascular surgeons were taught that the success of vascular access depended on the availability of a suitable vein preferably at the wrist. This was absolutely correct during the first decade after the publication of the ingenious idea by Brescia and Cimino in 1966 to construct an arterio-venous fistula for maintenance haemodialysis. At that time, only patients younger than 40 years were accepted for chronic dialysis programmes. Diabetes was considered a contraindication to dialysis treatment [1]. Thus, the quality of the venous system was indeed the only factor taken into account.
Reality
Time has changed. The number of diabetic and elderly patients has increased dramatically worldwide, especially type II diabetes has become more prevalent with
Lessons learned
Patho-morphological properties of the arterial vasculature
Preoperative evaluation
Surgical consequences
Perspectives
References
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