There are many choices of devices as technique for achieving permanent internal vascular access. The simplest one that offers reasonable success should be used.
To select the best location for construction of an arteriovenous fistula for vascular access, the surgeon must be sure that the vein to be used is adequate to promote success of the fistula and that the arterial supply remaining as adequate to ensure satisfactory perfusion of the limb. Often patients who need vascular access have had a chronic illness and have required repeated phlebotomyintravenous infusions which may cause thrombosis of many superficial veins. The venous lumen must be patent at the anastomosis and proximally. Careful clinical examination and duplex scanning can evaluate it. If necessary phebography can be used to determine the anatomy and examine the suspected area of stenosis.