Due to the shortage of donor organs, complicated medical problems, or for economic reasons, the number of end-stage renal failure(ESRF) patients requiring maintenance dialysis in Korea has been consistently increasing. Despite the rapid growth of
renal
transplantation(RT), less than 20% of patients have had the privlege of RT. Therfore, the importance of HD as a miantenance or bridging measure until RT should not be overlooked even in the era of chimera. To improve patient survival and quality
of
life, comfortably located, well functioning, potentially permanent angioaccess is mandatory. This review summarizes our 14 year experience with internal vascular access procedures, especially focusing on the importance of early failure(EF).
For the successful vascular access for maintenance HD, selection of types of surgery according to the size or status of vein is important to reduce EF, which is one of the major factors influencing long-term patency. In every sense, side to end
radiocephalic fistula(SERCF) at wrist level should boe tried initially. But if the cephalic vein is not suitable, there is no reason to explore the wrist, because, even after successful anastomosis, venous outflow might be inadequate to prevent
cannulation In this situation, the brachio cephalic fistula(BCF) at the antecubital fossa have to be preferied as the primary choice. We could achieve more than 70% of 3-year success rates with the RCF or BCF if the vein was good. More perfect
techniques and attentions are necessary to reduce early complications sucli as bleeding or wound problems.
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