Construction of arteriovenous fistulas for hemodialysis.

Establishment of a dependable means of venous access is vitally important to patients who require hemodialysis. Physical examination and phlebography are used to assess the most appropriate site for arteriovenous fistula construction. The radial artery and cephalic vein near the wrist should be used whenever possible, but several alternative procedures are available, including the brachiocephalic fistula, and saphenous vein and bovine heterograft interposition. Each operation contributes immeasurably to the comfort and survival of patients with terminal renal failure, and each must be performed with careful attention to detail.