Nine years' experience with end-to-end arteriovenous fistula at the ‘anatomical snuffbox’ for maintenance haemodialysis

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Abstract
One hundred and seventy-seven end-to-end arteriovenous fistulas were created at the ‘anatomical snuffbox’ between 1 January 1972 and 31 December 1980. The survival rate of the fistulas was 83·1 per cent at 1 year and 46·3 per cent at 6·5 years; 10·2 per cent failed immediately. Local and general complications were virtually absent. Forty fistulas stopped functioning after a period varying from 10 days to 6·5 years following the operation. The main cause of late failure (50 per cent) was aneurysm formation due to repeated needle venepuncture at the same site and subsequent obliteration of the upper venous segment. The end-to-end anastomosis seems to be preferable to other techniques because of the absence of local vascular complications and a lower risk of cardiac embarassment. The ‘anatomical snuffbox’ site is convenient and spares the proximal vessels for reoperation if necessary.