Approach to patients with end-stage renal disease who need an arteriovenous fistula.

Vascular access management is central to maintain the health and quality of life of end-stage renal disease (ESRD) patients. Early referral to a nephrologist for a decision about replacement therapy, preservation, clinical evaluation of vessels and planning for timely placement of an arteriovenous fistula (AVF) should be done. The number of patients with diabetes, peripheral vascular disease and older age continues to increase. In order to select the most functional vessels for the creation of an AVF, duplex ultrasound is recommended in this group of patients. Distensibility of the vein at proximal compression, measurement of the internal diameter of the artery, change of arterial resistance index at reactive hyperaemia and arterial blood flow are important parameters for the decision on the location and time of AVF construction in patients with marginal quality of vessels. Expansion of blood volume at the time of AVF surgery could be helpful in this group of patients. The consequences of such a procedure include fewer surgical interventions, earlier maturation of the AVF, less stress for the patients and, last but not least, lower costs of AVF surgery.