The initial creation of native arteriovenous fistulas: Surgical aspects and their impact on the practice of nephrology

A highly welcomed, increasing number of arteriovenous fistulas (AVFs) has been noted in recent years as has a high rate of early failure. The latter is not an inevitable consequence of the former. Potential contributors may be identified by an analysis of surgical strategies and details of the creation of arteriovenous (AV) anastomoses. The simple AVF is all but simple. Construction of the anastomosis is a tool, not the aim of access surgery. The aim is a rapidly maturing and well-functioning fistula, a high flow construct that can be cannulated easily and repeatedly for adequate hemodialysis (HD) therapy. Surgical details are illustrated to clarify verbal descriptions. The impact of a high quality of initial vascular access on the practice of nephrology is mentioned. Closing remarks try to define a vascular access team as the optimal option for future management of vascular access.