The Brescia-Cimino arteriovenous fistula (BC AVF) is the classic fistula for the patients with end-stage renal failure. And the traditional BC AVF is a side-to-side AVF. Is there really space for this type of AVF? 

I think there is. A side-to-side BC AVF is a fistula that can be done in certain conditions and offers a lot of technical advantages. Let’s see.

Where can it be done. This fistula is ideal when the cephalic vein has not been dissected down to its bifurcation on the wrist area. If the bifurcation has been found then the vein must be divided distally on the two branches. Then the two branches will be spatulated together on a unique large orifice which will be good enough to accommodate an end-to-side anastomosis to the radial artery. On the other hand, if the bifurcation has not been found (or does not exist) then a side-to-side anastomosis between the cephalic vein and the radial is feasible.

Benefits. The main benefit is that both vessels (vein and artery) are lined up together side by side, with no danger of twisting or disorienting. Thus, the anastomosis is safe and easy. Additionally, at the end of the procedure, the AVF can be transformed from side-to-side to end-to-side by simple ligating the vein just distally to the anastomosis.


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