Abstract
Thirtyβfive years after Brescia et al. (N Engl J Med 275:1089β1092, 1966) realized the first peripheral autogenous arteriovenous fistula, the βAchilles' heelβ of chronic dialysis is still the absence of a goodβquality permanent vascular access. The number of patients depending on hemodialysis is increasing. Until 10 years ago, in Romania, there was a need to treat isolated critical cases. Nowadays, every dialysis center needs algorithms for a standardized approach, adaptable for each case. We reviewed 171 consecutive arteriovenous fistulas (132 patients) performed in adults in identical standard conditions: use of an inflatable tourniquet during the vascular dissection, microsurgical techniques, and use of only autogenous tissues. We analyzed our results, the technical difficulties encountered, and their management in longβterm followβup. The aim of this study was to set up the basic principles of our algorithms. Our approach, based on our education as plastic surgeons involved in hand surgery and microsurgery, might present the advantage of sparing renal patients vascular capital. Β© 2003 WileyβLiss, Inc. MICROSURGERY 23:226β232 2003