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Nephrol Dial Transplant (2002) 17: 376-379
© 2002 European Renal Association-European Dialysis and Transplant Association

Invited Comment

The anastomosis of the arteriovenous fistula—common errors and their avoidance

Klaus Konner

Dialysis Unit, Krankenhaus Köln-Merheim, Köln, Germany

Introduction

In 1966, Brescia, Cimino and colleagues described the surgical creation of an arteriovenous fistula (AVF) to establish a vascular access in haemodialysis patients [1]. Despite the availability and the wide-spread use of grafts in some parts of the world, mainly ePTFE (expanded polytetrafluoroethylene), practically all experts in the field strongly advised creating an AVF whenever possible because of its lower rate of complications [2].

Despite the generally low rate of complications of native AVF, early failure within 1 month has been observed in some series in up to 29% of patients [3,4]. Early failure, defined as non-function of the AVF, is mostly caused by early thrombosis secondary to errors in surgical technique. Thoughtful analysis of the techniques of surgical creation of an arteriovenous anastomosis has identified a number of potential errors which may contribute to such early failure and which will be . . . [Full Text of this Article]

Haemodynamics of the AVF

The arteriovenous anastomosis

Prerequisites
Technical errors

Artery-side-to-vein-side anastomosis
Artery-side-to-vein-end anastomosis
Handling of the vein
The suture
End-to-end anastomoses
A comment concerning grafts
The suturing material
Non-surgical causes of early clotting
Comment

Notes

References


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Home page
 J. Am. Soc. Nephrol.Home page
K. Konner, B. Nonnast-Daniel, and E. Ritz
The Arteriovenous Fistula
J. Am. Soc. Nephrol., June 1, 2003; 14(6): 1669 - 1680.
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