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The AVF is considered the best surgical

approach to conventional hemodialysis. It is

defined as the anastomosis latero-lateral or

latero-terminal of an artery and a vein in the

vicinity.

I Anatomophysiological Recalls:

The anatomy of the veins of the arms is quite

variable from one individual to another, but

there is, however, four superficial veins used:

The cephalic vein, basilic, ulnar and radial. The

preliminary study by the surgeon, vessels, is

essential to achieving a quality FAV. The

assessment will first be clinically by palpation of

the pulse examination of veins with and without

tourniquet, study of their discharge. It may benecessary to achieve an ultrasound or

venography, especially in diabetics. The Allens

test seems unnecessary.

It is essential to require teams of nurses, to

maintain maximum capital of the renal vein, at

any stage, by avoiding any aspiration or infusion

of these veins.

II Surgery:

The plexus block by axillary or subclavian is the

most used, promoting vasoplegia. Sometimes

local anesthesia with or without

neuroleptanalgesia may be indicated, general

anesthesia is reserved for some special cases, as

it almost always accompanied by hypotension

embarrassing perception clinic.

The intervention must be economical of veins

and arteries, ideally 4 to 5cm, most fistulas

eventually be complicated and require further

surgery. The vessels should not be pinched, and

irrigation serum throughout the intraoperative

time may be necessary to prevent drying of

tissue and blood vessels. The anastomosis is

performed either in latero-lateral or latero-in

terminal. Closure in two layers, a very precise

way, avoiding areas of necrosis and secondary

scarring.

A subcutaneous injection of Xylocaine

containing a few drops of nitroglycerin can

reduce the spasm and allows a better venousdilation clamping. Similarly, an injection of

diltiazem periarterial eliminates arterial spasm

during dissection.

Radial fistulas:

It is created near the wrist in the gutter of the

pulse, by anastomosis of the radial artery and

low dorsal vein of the thumb. If the vein is very

close to the artery, it is often preferred a-side

anastomosis. The anastomosis may also,

depending on the quality of ships, be performed

in more proximal position.

Ulnar fistulas:

They are made near the wrist between the

ulnar artery and superficial ulnar vein.

III Time after surgery:

The nurse should monitor the vibration by

palpation, and the blast and its intensity with a

stethoscope, the lack of bruising or bleeding.The member will be extended or slightly

elevated, with a bending prohibited on the

operated limb. He will learn during

hospitalization, the patient, monitor his daily

fistula.

Later, the patient may again use its normal

member.

IV Training of the AVF:

The high blood flow caused by the anastomosis

will cause a gradual increase in the size of

arterialized veins. Turbulence at the

anastomosis are responsible for the perceived

thrill to palpation, and received blows to the

stethoscope. This must be heard to the elbow.

After a few months, the AVF will evolve towards

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an equilibrium, with the occurrence of stenosis

of variable localization. Over time can appear

sinuosities arterial and venous induration and

localized expansion, including puncture normal.

V Complications:A Thrombosis:

This is the most common complication, often a

result of poor venous, or sometimes, a technical

foul. In case of unexplained thrombosis

(intervention perfectly satisfactory and

successful initial operation), it will be done

laboratory tests to search for a bleeding

disorder.

B hematoma:

It is not uncommon, but it is unusual for its size

leads to a compression requiring surgical

evacuation.

C Hemorrhage:

Early and moderate bleeding is usually due to a

lack of hemostasis on a small vein

pressurization after fistula creation. Moderate

compression, associated with elevation of the

limb, often helps to address this situation.

By cons, an early arterial bleeding, often

abundant, follows a lack of anastomosis,

requiring further surgery in an emergency.

Ischemia may occur, especially in diabetics,

variable, ranging from simple hand feel cold to

acute ischemia, sometimes requiring, again, an

emergency reoperation.

D stenosis:

She sits in a privileged way near the

anastomosis and anatomical peculiarities

(valves, bends), but can be consecutive to

frequent venipuncture prior to arterialization.

Stenosis causes an obstacle to the flow of

blood, then the agency seeking to circumvent it

by developing collateral circulation could be

significant.

Stenosis causes a low throughput, a thrill and a

low breath, and difficulty of the puncture,

sometimes requiring hemodialysis sessions withtourniquet!

E Infection:

It may be discreet, limited to redness at the

puncture site, or own a clot on an ulcer, or

conversely, take the form of an abscess

puncture associated with inflammation free,

pulsatile hematoma or ulceration sanious. The

infection can be extremely serious because it

may diffuse away on heart valves in particular.

F Other complications:

Note also, but had not developed specifically

names speak for themselves:

The aneurysm and the lack of development of

the AVF.