ABSTRACT
No discussion of establishing chronic vascular access for hemodialysis with prosthetic grafts could commence without emphasizing the one observation that has persisted throughout the medical literature for the last 30 years: Autogenous native arteriovenous (AV) fistulae have performed best in maintaining uninterrupted access for hemodialysis-better than any other configuration-since their first description by Brescia et al. in 1966 (1). All patients who have chronic renal insufficiency and are in need of chronic vascular access for hemodialysis should be considered for construction of a native fistula prior to placement of a prosthetic graft. With the availability and effectiveness of long-term central venous dialysis catheters (see Chapter 7), even patients who present with an acute need for renal replacement therapy can be maintained via this access route, allowing for the creation and maturation of a native arteriovenous fistula. (Table 5.1).
