Vascular access for hemodialysis.

The subcutaneous arteriovenous fistula has become the method of choice for vascular access for chronic hemodialysis in the vast majority of dialysis centers in the United States and abroad. The Silastic cannula external arteriovenous shunt is an acceptable alternative and is the access of choice for treatment of acute renal failure or drug overdose. Surgeons dealing with these patients will have to familiarize themselves with both procedures, as well as with the various modifications currently in use in order to offer the best procedure for the particular patient and to make dialysis possible for all patients who need it.