The AVF is considered the best surgical approach to conventional hemodialysis. It is defined as the anastomosis latero-lateral or latero-terminal of an artery and a vein in the vicinity.
I – Anatomophysiological Recalls:
The anatomy of the veins of the arms is quite variable from one individual to another, but there is, however, four superficial veins used: The cephalic vein, basilic, ulnar and radial. The preliminary study by the surgeon, vessels, is essential to achieving a quality FAV. The assessment will first be clinically by palpation of the pulse examination of veins with and without tourniquet, study of their discharge. It may be necessary to achieve an ultrasound or venography, especially in diabetics. The Allen’s test seems unnecessary.
It is essential to require teams of nurses, to maintain maximum capital of the renal vein, at any stage, by avoiding any aspiration or infusion of these veins.
II – Surgery:
The plexus block by axillary or subclavian is the most used, promoting vasoplegia. Sometimes local anesthesia with or without neuroleptanalgesia may be indicated, general anesthesia is reserved for some special cases, as it almost always accompanied by hypotension embarrassing perception clinic. (more…)