SINCE description of arteriovenous anastomosis at the wrist as a means of providing subcutaneous arterialized veins which are easily used for repeated hemodialysis (Brescia et al1), this operation has been undertaken in many centers. When technically successfully, advantages are freedom from infection, hemorrhage, and thrombosis, complications which are frequent with external arteriovenous shunts.
In patients with well-developed subscutaneous forearm veins, side-to-side anastomosis with the radial artery is not difficult. However, in patients with small veins, and especially in women, there is a significant risk of failure due to thrombotic occlusion within the vein. Our experience with repeated hemodialysis in 50 patients in whom arteriovenous fistulas have been created will be reported. The purpose of this paper is to describe a technique which has allowed success in eight of nine consecutive operations in women with small veins.
Operative Procedure
Brachial plexus block anesthesia is preferred, as this inhibits spasm of