Hemodialysis upper limb arteriovenous fistula (AVF) creation is a procedure performed for hemodialysis access in those with end-stage renal failure. It connects an artery to a vein in the upper limb. 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:
- forearm arteriovenous fistula
- radial artery to cephalic vein (radiocephalic fistula)
- radial artery to basilic vein or other suitable forearm veins (transposition)
- upper arm arteriovenous fistula
- brachial artery to cephalic vein (brachiocephalic fistula)
- brachial artery to basilic or other suitable upper arm veins (transposition)
- dual outflow fistula
- brachial artery to cephalic and basilic vein
- radial artery to cephalic and basilic vein
- forearm graft
- brachial artery and median antecubital vein, a “loop” graft
- upper arm graft
- brachial artery and high brachial vein or basilic vein, a “straight” graft
On this page:
Radiographic features
Preoperative assessment
Ultrasound
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
Venography
Content pending.
Postoperative assessment
Ultrasound
Ultrasound is mainly used to assess for patency and complication.
Venography
Content pending.
Complications
- non-maturity
- outflow stenosis: some publications suggest a flow velocity of 400 cm/s or greater is indicative of a stenosis 5
- thrombosis/occlusion
- hematoma
- pseudoaneurysm formation
- aneurysm formation: aneurysms associated with arteriovenous fistulae (may occur in around 5% of cases 12)
- perigraft fluid