Secondary procedures for A-V fistula failure

There is a progressive increase of patients in the dialysis population in whom primary access by a Brescia-Cimino A-V fistula is no longer possible. These patients require secondary access procedures. Instead of using graft material several alternatives exist using the patient's own venous and arterial remnants, as morbidity and mortality of these procedures will be less than those where graft material is used. Long term patency rates of graft fistulae are disappointing, partially due to the damage to the graft by repeated punctures. A new device, which avoids needling, is briefly mentioned.