The anastomosis of the arteriovenous fistula—common errors and their avoidance

In 1966, Brescia, Cimino and colleagues described the surgical creation of an arteriovenous fistula (AVF) to establish a vascular access in haemodialysis patients w1x. Despite the availability and the wide-spread use of grafts in some parts of the world, mainly ePTFE (expanded polytetrafluoroethylene), practically all experts in the field strongly advised creating an AVF whenever possible because of its lower rate of complications w2x. Despite the generally low rate of complications of native AVF, early failure within 1 month has been observed in some series in up to 29% of patients w3,4x. Early failure, defined as non-function of the AVF, is mostly caused by early thrombosis secondary to errors in surgical technique. Thoughtful analysis of the techniques of surgical creation of an arteriovenous anastomosis has identified a number of potential errors which may contribute to such early failure and which will be discussed in the following.