Clinical Study on Blood Access (A-V shunts) for Chronic Hemodialysis

Blood access remains one of the most difficult problems of maintenance hemodialysis. From March 1971 to February 1977, 88 blood access were constrycted in 52 patients, ranging in age from 13 to 74 yrs. Thirty six cases in 15 patients were external A-V shunts, and the remaining 52 cases in 44 patients were subcutaneous A-V fistulas. The external A-V shunts are easy to place and readily usable, but are subject to frequent thrombosis and infection. Their short lifespan makes them unsuitable for chronic hemodialysis. The subcutaneous A-V fistula is ideal and best in terms of long term patency and freedom from complication. But unfortunately primary radial artery to cephalic vein fistula is not always possible. The vessels may have been damaged by previous use or be too small or too deep for reliable use. We created subcutaneous A-V fistulas with modified procedures for patients who cannot have a radiocephalic A-V fistula created. In our experience, modified A-V fistulas offer excellent long term patency with the fewest complications.