Techniques to enhance arteriovenous fistula maturation

Maturation of an arteriovenous fistula remains an elusive step in obtaining a good functional hemodialysis access outcome. Considerable variability in the performance of access procedures exists between surgical practices that are not necessarily well justified. Herein, a brief overview of techniques is presented to help in maximize the potential for maturing an arteriovenous fistula. These include arm vein preservation, arm vein duplex mapping, branch ligation, staged transposition/superficialization, and comprehensive follow-up and intervention program. Although definitive data may be lacking to show effectiveness in all areas reviewed, recommendations are made to help surgeons in working toward higher maturation rates. Further opportunities avail to developing clinical practice guidelines so as to give all end stage renal disease patients the best clinical experience.