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The AVF is considered the best surgical approach to conventional hemodialysis.

It is defined as the anastomosis latero-lateral or latero-terminal of an artery and a vein in the vicinity. I Anatomophysiological Recalls: The anatomy of the veins of the arms is quite variable from one individual to another, but there is, however, four superficial veins used: The cephalic vein, basilic, ulnar and radial. The preliminary study by the surgeon, vessels, is essential to achieving a quality FAV. The assessment will first be clinically by palpation of the pulse examination of veins with and without tourniquet, study of their discharge. It may be necessary to achieve an ultrasound or venography, especially in diabetics. The Allens test seems unnecessary. It is essential to require teams of nurses, to maintain maximum capital of the renal vein, at any stage, by avoiding any aspiration or infusion of these veins. II Surgery: The plexus block by axillary or subclavian is the most used, promoting vasoplegia. Sometimes local anesthesia with or without neuroleptanalgesia may be indicated, general anesthesia is reserved for some special cases, as it almost always accompanied by hypotension embarrassing perception clinic. The intervention must be economical of veins and arteries, ideally 4 to 5cm, most fistulas eventually be complicated and require further surgery. The vessels should not be pinched, and irrigation serum throughout the intraoperative time may be necessary to prevent drying of tissue and blood vessels. The anastomosis is performed either in latero-lateral or latero-in terminal. Closure in two layers, a very precise

way, avoiding areas of necrosis and secondary scarring. A subcutaneous injection of Xylocaine containing a few drops of nitroglycerin can reduce the spasm and allows a better venous dilation clamping. Similarly, an injection of diltiazem periarterial eliminates arterial spasm during dissection. Radial fistulas: It is created near the wrist in the gutter of the pulse, by anastomosis of the radial artery and low dorsal vein of the thumb. If the vein is very close to the artery, it is often preferred a-side anastomosis. The anastomosis may also, depending on the quality of ships, be performed in more proximal position. Ulnar fistulas: They are made near the wrist between the ulnar artery and superficial ulnar vein. III Time after surgery: The nurse should monitor the vibration by palpation, and the blast and its intensity with a stethoscope, the lack of bruising or bleeding. The member will be extended or slightly elevated, with a bending prohibited on the operated limb. He will learn during hospitalization, the patient, monitor his daily fistula. Later, the patient may again use its normal member. IV Training of the AVF: The high blood flow caused by the anastomosis will cause a gradual increase in the size of arterialized veins. Turbulence at the anastomosis are responsible for the perceived thrill to palpation, and received blows to the stethoscope. This must be heard to the elbow. After a few months, the AVF will evolve towards

an equilibrium, with the occurrence of stenosis of variable localization. Over time can appear sinuosities arterial and venous induration and localized expansion, including puncture normal. V Complications: A Thrombosis: This is the most common complication, often a result of poor venous, or sometimes, a technical foul. In case of unexplained thrombosis (intervention perfectly satisfactory and successful initial operation), it will be done laboratory tests to search for a bleeding disorder. B hematoma: It is not uncommon, but it is unusual for its size leads to a compression requiring surgical evacuation. C Hemorrhage: Early and moderate bleeding is usually due to a lack of hemostasis on a small vein pressurization after fistula creation. Moderate compression, associated with elevation of the limb, often helps to address this situation. By cons, an early arterial bleeding, often abundant, follows a lack of anastomosis, requiring further surgery in an emergency. Ischemia may occur, especially in diabetics, variable, ranging from simple hand feel cold to acute ischemia, sometimes requiring, again, an emergency reoperation. D stenosis: She sits in a privileged way near the anastomosis and anatomical peculiarities (valves, bends), but can be consecutive to frequent venipuncture prior to arterialization. Stenosis causes an obstacle to the flow of blood, then the agency seeking to circumvent it

by developing collateral circulation could be significant. Stenosis causes a low throughput, a thrill and a low breath, and difficulty of the puncture, sometimes requiring hemodialysis sessions with tourniquet! E Infection: It may be discreet, limited to redness at the puncture site, or own a clot on an ulcer, or conversely, take the form of an abscess puncture associated with inflammation free, pulsatile hematoma or ulceration sanious. The infection can be extremely serious because it may diffuse away on heart valves in particular. F Other complications: Note also, but had not developed specifically names speak for themselves: The aneurysm and the lack of development of the AVF.