Page 6 - Virtual Vascular Vol 3

Preoperative duplex ultrasound mapping of both upper limbs

Criteria for a well functioning fistula

A mature fistula should have:

• Adequate blood flow > 600ml/min

*For Asian, venous luminal diameter of >2mm is considered adequate as outflow for
AVF creation • Adequately matured > 6mm diameter

Non-dominant arm preferrable • < 6mm below skin surface

Distal to proximal, to preserve proximal sites

• Straight segment of at least 6cm
At wrist No At elbow No No
Good radial artery Good brachial artery Adequate Basilic vein AV Graft
Adequate cephalic vein Adequate cephalic vein

Yes Yes Yes • Post op review and Duplex assessment at 6 weeks

Radiocephalic (snuffbox or wrist) AVF Brachiocephalic (elbow) AVF Basilic vein transposition

- No further revision possible, same algorithm used on

dominant arm “Rule of 6’s”

- No further revision possible, lower limb long

saphenous vein loop AVF, followed by AV graft at upper

limbs, followed by AV graft at lower limbs

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