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Updated: Nov 14, 2025
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Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
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Is the Fistula First Approach still valid?
1Fundação Pró-Renal Brasil, Centro de Nefrologia Intervencionista, Curitiba, PR, Brasil.
Jornal Brasileiro De Nefrologia
|March 8, 2021
Summary
Arteriovenous fistulas (AVFs) are not always best for all patients. Arteriovenous grafts (AVGs) may offer better primary success and outcomes in specific patient groups, challenging the "fistula first" approach.
Area of Science:
- Nephrology
- Vascular Surgery
- Dialysis Access
Background:
- The Fistula First Breakthrough Initiative promoted arteriovenous fistulas (AVFs) over arteriovenous grafts (AVGs).
- This initiative significantly increased AVF prevalence and decreased AVG use in the US.
- However, the universal superiority of AVFs has been questioned.
Purpose of the Study:
- To re-evaluate the
Main Methods:
- Review of existing literature and clinical data comparing AVF and AVG outcomes.
- Analysis of primary failure rates, maturation times, and secondary access success.
- Consideration of patient-specific factors like age, comorbidities, and vessel quality.
Main Results:
- High primary AVF failure rates can lead to prolonged catheter use.
- AVGs demonstrate superior primary success and reduced catheter dependence in patients with non-ideal vasculature.
- In patients over 80, AVGs show similar survival to AVFs with fewer complications.
Conclusions:
- The
