Elbow arteriovenous fistulas for chronic haemodialysis

Arteriovenous fistulas (AVFs) were created at the elbow, rather than using prosthetic grafts, when forearm vessels were inadequate. A total of 272 such fistulas were constructed: 49 between the brachial artery and a forearm vein, 91 between the brachial artery and the elbow perforating vein, 52 between the brachial artery and the cephalic vein and 80 between the brachial artery and the basilic vein. In each case the vein was sutured end to side to the artery. The immediate failure rate was 11.8 per cent. The 1- and 4-year cumulative patency rates were 68.7 and 51.2 per cent for brachial artery-forearm vein AVFs, 80.3 and 68.0 per cent for those between the brachial artery and the elbow perforator, 74.1 and 61.3 per cent for brachial artery-cephalic vein fistulas, and 76.7 and 49.2 per cent for those between the brachial artery and the basilic vein. The elbow AVF is a reliable means of establishing vascular access for haemodialysis.