The first autogenous method for hemodialysis was introduced in 1966 by Brecia and Cimino in the distal forearm between the distal radial artery and the cephalic vein (distal radiocephalic method or the Brescia-Cimino method). Since then, various methods of arteriovenous fistula creation has been used which are different in surgical technique and location of the fistula. The Brescia-Cimino method, however, is the gold standard for arteriovenous fistula because of its technique and good long-term outcomes. In cases with no suitable vein for fistula in the wrist area, antecubital region can be tried. If no suitable vein was found in all regions, a synthetic graft is used.
As a result of variability in quality and diameter of the veins and the arteries and their relations, the surgeon's decision play an important role in choosing a proper location for fistula and leads to placement of more functional fistula. Proper venous diameter and quality are crucial anatomic properties needed for creation of a successful arteriovenous fistula. The vein should be at least 3 mm in diameter and the quality should not be impacted by previous blood sampling. Additionally, a short distance between the vein and its adjacent artery is important. Therefore, a narrow vein with a long distance from the artery will result in a difficult arteriovenous placement and impact its outcome.
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