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Related Experiment Video

Updated: Apr 30, 2026

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
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Elbow arteriovenous fistulae.

Teun Wilmink1

  • 1Consultant Vascular Surgeon, Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham - UK.

The Journal of Vascular Access
|May 13, 2014
PubMed
Summary

This paper classifies elbow arteriovenous fistulae (AVFs), recommending nontransposed brachiocephalic AVF for its low failure rate. It suggests tailoring AVF procedures to individual patient needs, especially when forearm veins are unsuitable.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Dialysis Access

Background:

  • Elbow arteriovenous fistulae (AVFs) exhibit diverse anatomical configurations.
  • Effective AVF creation is crucial for hemodialysis access.
  • Existing classifications may not fully capture the nuances of elbow AVF anatomy.

Purpose of the Study:

  • To describe the variety of elbow AVFs.
  • To propose a novel classification system for elbow AVFs.
  • To guide the selection of optimal AVF type based on anatomical and clinical factors.

Main Methods:

  • Review and analysis of anatomical variations in elbow AVFs.
  • Development of a classification system categorizing AVFs into nontransposed, transposed, and multiple outflow types.

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  • Evaluation of primary failure rates and medium-term survival based on AVF type.

    • Main Results:

    • The nontransposed brachiocephalic AVF demonstrates the lowest primary failure rate and good medium-term survival, particularly in elderly patients.
    • End-to-side anastomosis of the median cubital vein to the brachial artery is identified as a simple and effective technique.
    • Perforating vein AVFs with multiple outflow tracts may reduce primary failure risk in cases with small upper arm veins.
    • Elbow AVF creation is recommended when forearm veins are exhausted or inadequate, utilizing vein mapping with portable ultrasound.
    • Side-to-side AVFs for retrograde flow enhancement are rarely indicated due to risks of steal and venous hypertension.

    Conclusions:

    • A proposed classification includes nontransposed, transposed, and multiple outflow elbow AVFs.
    • Nontransposed brachiocephalic AVF offers favorable outcomes, especially for elderly patients.
    • AVF selection should be individualized, considering vein mapping and patient-specific factors, with transposed brachiobasilic AVF as a tertiary option.