Distal fistulas: tips, tricks and technical tweaks with Dr Lucas

In this fifth episode of Let’s Talk About Access, Dr Mallios welcomes Dr Lucas to share practical tips and tricks for creating successful distal arteriovenous fistulas.

They begin by discussing the growing popularity of snuffbox fistulas in recent years, before Dr Lucas explains his guiding principle: “the more distal you go, the lower flow fistula”. He details how he assesses vein suitability and discusses the importance of the distance between the vein and artery, as well as the technical challenge of vein rotation.

The conversation then turns to surgical technique, including vein preparation, the use of dilators, VasQ and anastoclips, and the choice between interrupted and continuous sutures.

Dr Lucas shares his results in terms of maturation and primary patency, comparing snuffbox fistulas with more conventional wrist-level Cimino fistulas. He also discusses the role of grafts, the impact of obesity on technique selection, and the patient profiles that may lead him to rule out fistula creation altogether.

Finally, he highlights a technical modification that can make a difference in achieving successful outcomes.

Hit play to discover the technical tips and surgical strategies that can help make distal fistulas a success.