Brachial artery-to-brachial vein arterio-venous fistula in a pediatric patient

The National Kidney Foundation's Disease Outcome Quality Initiative (NKF-DOQI) guidelines, produced in 1997, emphasized the superiority of arterio-venous fistulae (AVF) as vascular access in patients on chronic hemodialysis. Challenges in pediatric hemodialysis patients include poor superficial venous vasculature. We describe an approach to brachial artery to brachial vein AVF creation in a pediatric dialysis patient. The fistula is patent for greater than one year after creation. A great deal of passion and enthusiasm is a prerequisite for successful and technically challenging cases such as the one described.