Arteriovenous Fistulas

  • Wilhelm Schäberle


Of the 50,000 patients with end-stage renal failure in Germany, each year some 15,000 become candidates for creation of a hemodialysis access. A native arteriovenous (AV) fistula has a better prognosis with longer patency and fewer complications such as infections and is preferred to a synthetic graft (Tordoir et al. 2007). An advantage of a synthetic dialysis access is that it can be used earlier, while a native fistula needs time to mature before it can be used for hemodialysis. A synthetic shunt is the second option in patients whose native vein (typically the cephalic vein) is deemed unsuitable because of a small lumen or because it has undergone thrombotic or fibrotic degeneration as a result of frequent puncture. A minimum flow volume is necessary to ensure adequate dialysis treatment. Protocols in the USA require a flow volume of at least 350 mL/min, while smaller volumes of 200–300 mL/min are still considered acceptable in some European countries including Germany. This requirement informs the preoperative search for a suitable vein for creating an AV fistula and the identification of patients who need a synthetic vascular access. Preoperative vascular mapping contributes important information for selecting the most suitable hemodialysis access for each patient.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Wilhelm Schäberle
    • 1
  1. 1.Department of Visceral, Vascular, Thoracic, and Pediatric SurgeryAlb Fils KlinikenGöppingenGermany

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