AV fistula and AV graft for renal dialysis

1. AV fistula and AV graft for renal dialysis Vascular access for dialysis typically provided by placing prosthetic AV graft or creating AV fistula by surgical anastamosis of vein to artery (side-to-side or end-to-side). Vein proximal to AVF grows stronger, larger so can tolerate repeated needle sticks. http://health.yahoo.com/topic/urinary/treatment/article/mayoclinic/FA98AE58-DC50-4013-B9893CACAA2231DC

2. Arteriovenous Fistula Sinnamon and Mullan (2007) NEJM 357 (15): e16 50-year-old man. 30-yr end-stage renal disease assoc. with idiopathic membranoproliferative glomerulonephritis. Hx included immune thrombocytopenic purpura, with platelet counts persistently less than 15,000/mm3. After second renal transplant failed 8 years ago, patient began to undergo dialysis through left brachiocephalic arteriovenous fistula, which became severely aneurysmal over next 6 years (Panel A), with no evidence of proximal venous stenosis. No evidence of complications — infection, embolism, rupture, or high-output congestive heart failure — from this aneurysmal AV fistula. Patient underwent elective resection of the AV fistula, owing to possibility of life-threatening hemorrhage if fistula continued to increase in size. Surgical result was satisfactory (Panel B). A subsequent arteriovenous fistula was created in his contralateral arm, progressed in a similar manner over the next 18 months, and also required surgical resection. For the past 12 months, the patient has undergone hemodialysis through a third arteriovenous fistula that is currently nonaneurysmal.