[High-flux arteriovenous fistula at the anatomic snuffbox]

Based on 25 years of haemodialysis experience, the authors confirm the importance of arteriovenous fistula at the anatomic snuff-box by L-L anastomosis with vessel end-tie, and assert that, even using small vessels, through simple devices, it is possible to achieve high-flux vascular access, that can be employed also for high-efficiency treatments (HF, HDF). The advantages and the troubles of this vascular access are considered and also the reasons that lead to dropping this arterio-venous fistula too. The authors describe the surgical technique and the devices of the procedure, based on their case-reports of 131 arteriovenous fistulas at the anatomic snuff-box, immediately working in 95% of the cases and compatible with high-flux blood in 67% of cases. Fine adventitial bridle resection is very important, because this procedure allows us to rest the venous vessel wall on the top of the fistula; the ligature of all collateral vessels is very important too. The arteriovenous fistula at the anatomic snuff-box (L-L terminated, with anastomotic leak of 5 mm) is the most advisable vascular access for all the patients in whom we can plan the start of dialysis some months advance.