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Related Concept Videos

Hemodialysis I: Introduction01:25

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Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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Related Experiment Video

Updated: Feb 18, 2026

Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
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Autogenous forearm loop arteriovenous fistula creation.

Weng Jun Tang1, Arman Zaharil Mat Saad1

  • 1Reconstructive Sciences Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian - Malaysia.

The Journal of Vascular Access
|November 18, 2017
PubMed
Summary

Forearm loop arteriovenous fistulas offer a viable alternative for end-stage kidney disease patients with severe atherosclerosis, preserving upper arm vessels. Six out of nine fistulas remained functional after one year, demonstrating their potential for long-term hemodialysis access.

Keywords:
Atherosclerotic arteryEnd-stage kidney diseaseLoop arteriovenous fistula

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Dialysis Access

Background:

  • Arteriovenous fistula (AVF) is critical for hemodialysis in end-stage kidney disease (ESKD) patients.
  • Vessel quality significantly impacts AVF function and longevity.
  • Preserving upper arm vasculature is essential for future interventions.

Purpose of the Study:

  • To evaluate the forearm loop AVF as an alternative hemodialysis access.
  • To assess the feasibility of forearm loop AVF in patients with severe distal artery atherosclerosis.
  • To preserve upper arm vasculature for potential future AVF creation.

Main Methods:

  • A retrospective study of 202 ESKD patients (CKD stages 4-5) from October 2015 to September 2016.
  • Nine patients with severe distal artery atherosclerosis and suitable veins underwent forearm loop AVF creation.
  • Fistula maturation assessed using National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) criteria.

Main Results:

  • All nine patients had diabetes mellitus for over 10 years.
  • One fistula failed to mature within 6 weeks; two thrombosed at 3 and 5 months.
  • Six fistulas achieved successful maturation and remained functional after one year of hemodialysis.

Conclusions:

  • Distal forearm arteries in diabetic patients can exhibit severe atherosclerosis.
  • Forearm loop AVF is a viable option for patients unsuitable for traditional fistula creation due to atherosclerotic disease.
  • This approach effectively preserves upper arm veins for subsequent access procedures.