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Haemodialysis access
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== Forearm: == * Cephalic vein ** Better than the basilic vein due to its lateral location and the need for only minimal dissection ** Inflow sites: (as distal as possible, so in order of preference) *** '''Posterior branch of radial artery in the 'snuffbox'''' **** If cephalic vein is too deep (obese patients), autogenous radial-cephalic forearm transposition is performed *** '''Trunk of radial artery (Brescia-Cimino-Appel fistula)''' **** See above - if cephalic vein is too deep (obese patients), autogenous radial-cephalic forearm transposition is performed *** '''Ulnar artery (harder due to distance)''' *** '''Brachial artery''' * Basilic vein ** Used when cephalic vein is inadequate ** Transposition is always required due to its medial location ** Arterial inflow: *** Distal radial artery **** Posterior branch is not possible due to distance *** Ulnar *** Proximal radial *** Brachial * Alternate vein ** It is possible to translocate the femoral and saphenous veins to the forearm * Prosthetic graft ** Controversial whether to prioritise forearm prosthetic access or upper arm autogenous access
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