Strategy for maximizing the use of arteriovenous fistulae.

Increasing the use of arteriovenous fistulae in dialysis patients requires a specific strategy. In order to properly select patients for an arteriovenous fistula (AVF), it is essential that the nephrologist become knowledgeable about the subject and that an organized approach be followed. Both the arterial and venous systems must be evaluated. Evaluation of medical history, general physical examination, specific physical examination related to the vasculature of the extremity, vein mapping and duplex ultrasound studies are all important. It is very important to assess the size of the vessels involved. Although a newly created AVF should be allowed to fully mature prior to use, failure to develop should be evaluated early. Many cases of early failure can be successfully salvaged. Even if the patient has an arteriovenous graft, they should be evaluated at the time of every graft failure for the possibilities of creating a secondary AVF.