When insufficient arterial inflow becomes the Achilles heel of the av-fistula—what are the surgical approaches?

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Abstract
Generations of nephrologists and vascular surgeons were taught that the success of vascular access depended on the availability of a suitable vein preferably at the wrist. This was absolutely correct during the first decade after the publication of the ingenious idea by Brescia and Cimino in 1966 to construct an arterio-venous fistula for maintenance haemodialysis. At that time, only patients younger than 40 years were accepted for chronic dialysis programmes. Diabetes was considered a contraindication to dialysis treatment [1]. Thus, the quality of the venous system was indeed the only factor taken into account.