Clinical Review

Management of arteriovenous fistulas

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6262 (Published 30 October 2014) Cite this as: BMJ 2014;349:g6262
  1. Abul Siddiky, specialty registrar in transplant and general surgery1,
  2. Kashif Sarwar, general practitioner2,
  3. Niaz Ahmad, consultant in transplant surgery3,
  4. James Gilbert, consultant in transplant and vascular access surgery4
  1. 1CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
  2. 2Leeds City Medical Practice, Leeds, UK
  3. 3Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Oxford University Hospitals NHS Trust, Oxford, UK
  1. Correspondence to: A Siddiky ahsiddiky@doctors.org.uk

Summary points

  • The number of patients requiring haemodialysis is increasing worldwide

  • Arteriovenous fistulas provide the ideal means to achieve vascular access for haemodialysis

  • Such fistulas are generally well tolerated

  • Complications include infection, thrombosis, stenosis, aneurysmal change, steal syndrome, and high output cardiac failure

  • An arteriovenous fistula effectively acts as a patient’s lifeline and therefore should be looked after carefully

The global incidence of patients requiring renal replacement therapy is increasing.1 In 2012, 108 per million adults in the United Kingdom started renal replacement therapy, with a prevalence of 861 per million population.2 Haemodialysis is one of three viable options for renal replacement therapy alongside renal transplantation and peritoneal dialysis. In 2012 in the United Kingdom, 20 332 adults were receiving haemodialysis, accounting for 42.7% of all renal replacement therapy and 2.3% more patients than in the preceding year. This is a worldwide problem, with a little over 370 000 people in the United States and approximately 10 500 people in Australia and New Zealand also receiving haemodialysis.3 4 The purpose of this review is to provide non-specialists with an overview of arteriovenous fistulas and potential complications.

Sources and selection criteria

We searched Medline, the Cochrane Database of Systematic Reviews, and Clinical Evidence online using the search terms “arteriovenous fistula”, “vascular access for haemodialysis”, or “renal replacement therapy” for articles published between 1990 and 2014. Whenever possible we focused on systematic reviews, meta-analyses, and high quality randomised controlled trials. We also consulted the UK Renal Association guidelines (2011) and the US National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines (2000).

What is an arteriovenous fistula?

An arteriovenous fistula is a direct connection between an artery and a vein, created surgically or occurring as a result of pathology. Surgically created fistulas were first described in 1966 following observation of the ease of phlebotomy and relatively unaffected health of Korean …

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