Dialysis Fistula

Dialysis fistula creation is a commonly performed procedure for patients who suffer from end-stage renal disease (ESRD) who require permanent vascular access in order to receive long-term hemodialysis. The ideal dialysis fistula delivers a high flow rate sufficient for effective dialysis, is suitable for repeated cannulation, and has long-term patency rates with minimal complications. According to the National Kidney Foundation, over 400,000 patients are treated with hemodialysis in the United States with medicare spending, on average, 90,000 USD per patient per year of treatment. While there are various techniques for permanent dialysis access, arteriovenous fistulas (AVFs) are proven to have superior clinical and economic advantages. Guidelines from the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) and the Fistula First Initiative recommend that autogenous AVFs should be considered as the preferred initial access for hemodialysis in patients with ESRD, followed by prosthetic grafts, and finally hemodialysis catheters. Studies have demonstrated a clinically significant decrease in the rate of infections, hospitalizations, catheter failure, central venous stenosis, and mortality, as well as overall cost with AVFs compared to prosthetic grafts or hemodialysis catheters. Despite the prolonged maturation time that delays immediate use, patency rates for AVFs range from 3 to 5 years, compared to 1 to 2 years for AV grafts. This article will discuss the relevant anatomy, indications, contraindications, procedure details, and complications associated with arteriovenous dialysis fistula creation.