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6 eGFR Equations (beta)


AV Fistula


1997 Andrew Lundin, M.D. All rights reserved. Reproduced with permission.


Is it feasible or desirable for a person who has a graft grow a fistula?

A native (Cimino-Brescia - named after the doctors who first did one in 1966) fistula is, without doubt, the best HD access. Mine was constructed by a master craftsman and is still working 29 years later, surviving 5.5 years of a transplant. Others have described a similar experience. After the transplant the surgeons offered to close the fistula. Their trust in the permanence of cadaveric transplants was stronger than mine.

As to the question, if you can get a fistula use the graft while the fistula is developing then lose the graft.

Not all surgeons are created equal in their ability to make good fistulas. This is one area where word-of-mouth or a shoppers' guide is well worth the effort.

Would it have to be on the other arm?

Generally, but would let the surgeon make the judgement.

Would the button hole technique be good for a person with a graft or would it not matter?

I have used the button-hole technique for most of the 29 years that I have had the fistula. Three arterial spots and three venous spots rotated during the week. If I were to do daily dialysis, I could find a few more pairings.

I think the button-hole technique would be a problem with grafts because of the artificial material that would not heal like real tissue. In fact I suspect the hole would just get bigger with time causing loss of the graft.

Peter Lundin, M.D.

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