ABSTRACT
From the beginning, the full potential of hemodialysis for the long-term treatment of patients with chronic renal failure was limited by the lack of a means for repeated access to the vascular system. At the outset, it was necessary for repeated cutdowns to be made on an artery and vein for each dialysis, following which the vessels were ligated. The duration of a course of dialysis was, therefore, limited to the treatment of acute renal failure. W. J. Kolff, the designer of the first practical dialysis machine, observed in 1944, “when a preparation of the arteries was necessary (all veins being ruined) very persistent hemorrhages arose from the subcutaneous tissue owing to the heparine. . . . After the 12th dialysis became a failure, the artery being damaged, the urea percentage of the blood rapidly rose to 640mg percent whereupon death followed.”[1]
Scribner, Dillard, and Quinton[2] (an internist, a surgeon, and an engineer) in 1960 introduced the first successful apparatus for provision of reasonably long-term cannulation of an artery and vein using an external Silastic shunt. This was widely adopted over the succeeding 6 years, up to the time Cimino and coworkers[3] reported their success, in 1966, with the autologous, subcutaneous arteriovenous fistula. This “arterialized” superficial arm vein could be repeatedly cannulated, and it has stood the test of time, remaining today the best method for provision of long-term vascular access.
