Explanation:
- AVF graft is not needed since fistula has matured but has developed a stenosis – If an AV fistula does not mature, an AV graft is the second choice for a long-lasting vascular access. An AV graft is more likely than an AV fistula to have problems with infection and clotting- AV grafts do not require maturation, as AV fistulas do, and that they can be used for hemodialysis in as little as 24 hours after creation depending upon the type of graft that is used. AVGs are indicated when superficial veins are unavailable or to repair a native AVF (bridge graft).
- He has good bruit and thrill clinically , so confirmation by doppler is not needed.
- High grade stenosis is suspected due to whistling sound, pulsatile character of AVF
- button hole technique is used for when there is inability to rotate cannulation sites due to short segment of mature AVF or aneurysms . In this technique,a track is created with repetitive cannulation of the same path by sharp needles, followed by blunt needle cannulation.there is less chance of bleeding, pain, hematoma, and aneurysm formation.However infections from poor cannulation technique can be risk factor . .
Reference
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332078/
https://cjasn.asnjournals.org/content/8/7/1220
