Use of a Small Arteriovenous Anastomosis in Dialysis Access Creation

The size selection of the arteriovenous (AV) anastomosis in dialysis access creation requires a careful balance: the diameter must be large enough to accommodate sufficient flow for hemodialysis, but small enough to minimize the complication of steal syndrome. Steal syndrome affects up to 10% of patients after creation of dialysis access with sometimes devastating consequences. Conventional teaching recommends an 8- to 10-mm anastomosis. We sought to assess the efficacy of using a smaller (5-6 mm) anastomosis in new AV fistula (AVF) creation.