- Fistula first — catheter last coalition
- fistula is the most durable access
- Rule of 6s for AVF maturation:
- >600 mL/min
- <6 mm below skin surface
- min diameter 6 mm
- maturation 6 weeks minimum
- inflow artery
- outflow vein
- AVF juxta-anastomotic region- within 4 cm of the anastomosis
- avg- arterial limb, apex, venous limb
Ultrasound needed -
Arterial luminal diameter >=2 mm. Palmar arch complete. High origin of radial May cause delayed maturation.
Venous luminal diameter >=2.5 for avf, 4mm for avg. uninterrupted outflow needed. Paired brachial vein usually good for BC fistula interposition.
Transposition fistula after maturation
Loop Grady, C graft, necklace graft
central vein stenosis - only treat if symptomatic
steal syndrome - arterial flow only going into fistula.
Miller Branding procedure.
Megafistula- >2L/min. 3/4 L per minute- high output cardiac fistula.
radial artery aneurysm - from access of the radial artery
angioplasty >50% stenosis
When to stent- flow limiting dissections or major vascular rupture. Suboptimal angioplasty or recurrence within 3 months. Pseudosneurysms.
Percutaneous fistula placement