AV Fistula
© 1997 Andrew Lundin, M.D. All rights reserved.
Reproduced with permission.
Is it feasible or desirable for a person who has a graft
grow a fistula?
A native (Cimino-Brescia - named after the doctors who first
did one in
1966) fistula is, without doubt, the best HD access. Mine
was
constructed by a master craftsman and is still working 29 years
later,
surviving 5.5 years of a transplant. Others have described a
similar
experience. After the transplant the surgeons offered to close
the
fistula. Their trust in the permanence of cadaveric transplants
was
stronger than mine.
As to the question, if you can get a fistula use the graft
while the
fistula is developing then lose the graft.
Not all surgeons are created equal in their ability to make
good
fistulas. This is one area where word-of-mouth or a shoppers'
guide is
well worth the effort.
Would it have to be on the other arm?
Generally, but would let the surgeon make the
judgement. Would the button hole technique be good for a person with a
graft or would it not matter?
I have used the button-hole technique for most of the 29 years
that I
have had the fistula. Three arterial spots and three venous
spots
rotated during the week. If I were to do daily dialysis, I
could find a
few more pairings.
I think the button-hole technique would be a problem with
grafts because
of the artificial material that would not heal like real
tissue. In fact
I suspect the hole would just get bigger with time causing loss
of the graft.
Peter Lundin, M.D.
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