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In cases of chronic renal failure, the usual technique for vascular approach is an arteriovenous fistula (AVF). This is the vascular approach with the longest lifetime. Microsurgery has improved the realization technique. This technique was used between 1978 and 1987 in 370 adult patients. Distal AVFs are made as a priority to preserve the patient's vascular capital. Radial AVF is the basic technique. Complications, including thrombosis, aneurysms, stenosis, low flow rate, require second surgery that must often be repeated. Arteriovenous bypass with a saphenous or cubital venous graft is used in difficult cases. Bovine carotid artery grafts are still used as bypass grafts in occasional cases; their lifetime is usually short. Catheterization through a jugular (never subclavian) site is a temporary alternative.
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