Abstract: Objective To evaluate the effect and advantage of arteriovenous internal fistula at higher site in hemodialysis patients with dysfunction of standard arteriovenous fistula in forearm. Methods Arteriovenous internal fistula at higher site was made in 40 uremia patients whose vascular condition in forearm was inadequate for successful construction of an internal arteriovenous fistula. We then analyzed the advantages and complications of the internal fistulas at higher site. Results The operation was successfully performed in 39 cases and was failed in one case because of the bad vascularity condition; long-term deep vein catheterization
was then used in this case. The internal fistulas were used for hemodialysis after 4～8 weeks, and the blood flow can reach 230～300 ml/min. Blockage of the internal fistulas due to thrombosis was found in 4 cases. Swelling of distal limbs was detected in 5 cases, not affecting physical activity and blood access in hemodialysis. Conclusions Arteriovenous internal fistula at higher site can be successfully used in patients with poor vascularity condition in forearm. This operation can also protect patient's blood vessels for the preparation of vascular graft.

Key words: uremia, hemodialysis, arteriovenous internal fistula at higher site