When insufficient arterial inflow becomes the Achilles heel of the av-fistula what are the surgical approaches?
Medizinische Klinik I, Krankenhaus Köln-Merheim, Köln, Germany Correspondence and offprint requests to: K. Konner, Schauins Land 24, D-51429 Bergisch Gladbach, Germany. Historical notes Generations of nephrologists and vascular surgeons were taught that the success of vascular access depended on the availability of a suitable vein preferably at the wrist. This was absolutely correct during the first decade after the publication of the ingenious idea by Brescia and Cimino in 1966 to construct an arterio-venous fistula for maintenance haemodialysis. At that time, only patients younger than 40 years were accepted for chronic dialysis programmes. Diabetes was considered a contraindication to dialysis treatment [1]. Thus, the quality of the venous system was indeed the only factor taken into account. Reality Time has changed. The number of diabetic and elderly patients has increased dramatically worldwide, especially type II diabetes has become more prevalent with advancing age of the dialy
