AV Fistula / Dialysis Access

Best access for haemodialysis: native arteriovenous fistula (AVF) — long patency, low infection. Alternatives: AV graft (prosthetic — quicker maturation, higher infection / thrombosis), tunnelled central venous catheter (last resort, risk infection). Pre-emptive AVF creation: • Refer patients with eGFR <20 to vascular surgery for AVF creation 3–6 months before anticipated dialysis (allows maturation). • Vein mapping + arterial Doppler pre-op. • Common sites: radiocephalic (preferred), brachiocephalic, brachiobasilic transposition. • Maturation: ~6 weeks; assess by physical exam (thrill, bruit), USS (flow >600 mL/min, vein diameter ≥6 mm). • Pre-fistula vein protection: avoid IV cannulation in vein to be used.