Interventions for failed wrist fistulae: Is it worthwhile?

A well-functioning forearm fistula is considered as the most suitable access for dialysis. It is easy to construct, has the fewest number of complications and lasts for a long time. Many patients fail to enjoy this benefit due to the high rates of thrombosis and the failure to mature associated with this procedure. Attempts to salvage failed and failing fistula suggest that there is a group of patients where interventions can help provide this benefit. This article provides a brief review of current experience using surgical and interventional techniques to salvage failing forearm fistulae. It attempts to classify modes of presentation of access failure and different modalities used to salvage them. It also suggests an algorithm that can be used to identify patients who may benefit from these interventions and a guide to make the decisions related to selection of a treatment modality. Successful salvage of a failing forearm fistula provides the patient with an opportunity to enjoy all the benefits of this access.