Which of the following is not a preferred site for planning vascular access for maintenance hemodialysis?
2 types of vascular access designed for long-term use are aeriovenous fistula (AV fistula ) and AV graft. A third type of vascular access - the venous catheter - is for sho term use. The preferred sites for placing the AV fistula are (in order of preference) the wrist (radiocephalic) and the elbow (brachiocephalic) of the non dominant upper limb. These autogenous fistulae are always the first choice as they are likely to work longer and require less maintenance to keep them going. It is best to create a fistula as close to the hand as possible so that a long length of the vein in the forearm and arm is available for dialysis. If it is not possible to establish either of these types of fistula, access may be established using either a transposed brachial-basilic vein fistula or an AV graft of synthetic material ( e.g. , polytetrafluoroethylene ). The preferred site and type of graft is a forearm curved looped radiocephalic graft. This is followed by an upper arm straight graft. The least preferred sites and type of grafts are forearm straight radial cephalic and looped thigh grafts. However, the location for the graft placement is determined by each patient's unique anatomical restrictions, previous access history, and the surgeon's skill.
Nondominant extremity
Upper limb
Radiocephalic AV fistula
Saphenofemoral fistula
Urology