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< Vol. 16 Issue 2 | Mar-Apr 2015 | pp. 77 - 166, e6 - e74

Hemodialysis vascular access construction in the upper extremity: a review

Hemodialysis vascular access construction in the upper extremity: a review

J Vasc Access 2015; 16(2): 87 - 92

Article Type: REVIEW

Article Subject: Dialysis

DOI:10.5301/jva.5000299

Authors

Susie Q. Lew, Bao-Ngoc Nguyen, Todd S. Ing

Abstract

This article reviews the conventional vascular access types in the upper extremities for hemodialysis.

We performed a literature search for autogenous arteriovenous fistula in the upper extremities.

The upper extremities have four potential sites: radio-cephalic or radio-basilic transposition in the forearm, and brachio-cephalic or brachio-basilic transposition in the upper arm. A preoperative Duplex ultrasound provides valuable information regarding arterial inflow and venous outflow. The surgical approach to fistula formation and final product depends on vein diameter and length as well as proximal vein patency. The discussion focuses on access outcomes and management of common complications.

The upper extremity arteriovenous fistula is the preferred access for hemodialysis. A number of arteriovenous fistulas can be created in the upper extremities. The Duplex ultrasound identifies suitable arteries and veins for successful arteriovenous hemodialysis fistula creation. Arteriovenous hemodialysis fistula has the best long-term patency outcomes and the lowest associated morbidity and mortality. Early detection and intervention can save the fistula when complications occur.

Article History

  • • Accepted on 14/07/2014
  • • Available online on 04/09/2014
  • • Published in print on 14/04/2015

Disclosures

Financial support: The authors have no financial disclosures to make.
Conflict of interest: The authors have no conflict of interest.

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Authors

  • Lew, Susie Q. [PubMed] [Google Scholar] 1, * Corresponding Author (sqlew@gwu.edu)
  • Nguyen, Bao-Ngoc [PubMed] [Google Scholar] 2
  • Ing, Todd S. [PubMed] [Google Scholar] 3

Affiliations

  • Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia - USA
  • Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia - USA
  • Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois - USA

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