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AV fistula and AV graft for renal dialysis.
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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
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.