Abstract
Recent guidelines published by the National Kidney Foundation Dialysis Outcome Quality Initiative (DOQI) on vascular access has suggested that for patients requiring chronic hemodialysis, the preferred site for access is a native arteriovenous fistula (AVF). The recommendation of DOQI may cause an aggressive approach for creation of fistula rather than a graft. Although fistulae have longer patency as compared to grafts, a substantial number of fistulae do not function adequately either due to failing maturation or to thrombosis directly after the operation. We analyse the perioperative factors that are associated with early failure of hemodialysis access fistulae,in order to improve their functional patency. We also highlight the importance of multi-disciplinary approach including nephrologists, vascular surgeons and radiologists in ensuring optimal vascular access for hemodialysis patients.