Haemodialysis arm arteriovenous fistula

Last revised by Dr Daniel J Bell on 10 Aug 2021

Haemodialysis arm arteriovenous fistula (AVF) creation is a procedure performed for haemodialysis access in those with end stage renal failure. It connects an artery to a vein in the arm. This can either be a native connection or a connection using a PTFE (polytetrafluoroethylene) graft.

There are several types depending on the type of connection:

Upper arm mapping

A tourniquet is placed near the axilla, and the cephalic, basilic and brachial veins from the antecubital area to the cranial aspect of the upper arm are examined. Veins of acceptable diameter are followed into the subclavian vein to assess for stenosis or occlusion by using direct non-compressive assessment and compression techniques.

Assessment of draining veins

All draining veins are assessed for stenosis/thrombosis throughout their course with visual inspection and compression.

  • indirect central venous assessment
    • subclavian and jugular venous Doppler waveforms are analyzed for indirect evidence of central venous abnormality.
    • indirect evidence of stenosis or occlusion in the nonvisualised brachiocephalic vein and/or superior vena cava include
      • diminished respiratory phasicity
      • diminished transmitted cardiac pulsatility in the subclavian and jugular veins

Content pending.

Ultrasound is mainly used to assess for patency and complication.

Content pending. 

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Cases and figures

  • Case 1: with thrombosis
    Drag here to reorder.
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