The snuffbox fistula should be preferred over the wrist arteriovenous fistula

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Abstract

Objective:

The snuffbox arteriovenous fistula (SBAVF) is the most distal native vascular access. Although published data show a favorable outcome, the SBAVF is not strongly recommended by the guidelines. The present study compared the patency of SBAVFs and wrist AVFs (WAVFs).

Methods:

All 416 AVFs created by the same nephrologist from March 2006 to October 2014 were reviewed. From 416 procedures, 47 SBAVFs and 77 WAVFs with vessels suitable for a SBAVF were selected.

Results:

Although vessel diameters used for construction of the SBAVFs were smaller than those used for WAVFs, the outcome of vascular access was similar. At 18 months, primary patency was 72% for SBAVF and 65% for WAVF (P = .48), and secondary patency was 93% for SBAVF and 94% for WAVF (P = .89).

Conclusions:

In our experience, a SBAVF performs as well as a WAVF up to 18 months after creation. We suggest favoring SBAVF, especially in young patients without comorbidities, as the primary vascular access.

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