Prevention of thrombosis in arteriovenous fistulas.

To prevent thrombosis in arteriovenous fistulas it is necessary to obtain the knowledgeable cooperation not only of the whole health care team, but also of the patient. The first step is preservation of forearm veins by avoiding unnecessary venipunctures in patients with chronic renal failure. Fistulas should be constructed well in advance of need and use natural rather than prosthetic veins whenever possible. Major surgery elsewhere is a potential cause of fistula thrombosis. Fistula construction is often best delayed till major surgery is over and until the veins have recovered from the effects of systemic steroid therapy. Avoidance of premature fistula cannulation and correct needling techniques help to prevent vein wall damage. Alertness to the presence of high venous pressures on dialysis and observation of inefficient dialysis due to recirculation should lead to detection of narrowed segments which can be surgically corrected before thrombosis occurs. Antiplatelet drugs are of proven value in the prevention of recurrent thrombotic episodes.