tag:blogger.com,1999:blog-2744263723545918621.post5335796382195734344..comments2009-03-02T13:25:16.120-08:00Dr. Simon E. Prince, FACP, FASNhttp://www.blogger.com/profile/03460983023759293165sprince@nsneph.comBlogger2125tag:blogger.com,1999:blog-2744263723545918621.post-22445045962556284512009-03-02T13:25:16.120-08:002009-03-02T13:25:16.120-08:00Such a distinguished guest... I am honored, Dr Appell. Thank you for your contribution to the field of Nephrology.. as well as for taking the time to comment here.Dr. Simon E. Prince, FACP, FASNhttp://www.blogger.com/profile/03460983023759293165noreply@blogger.comtag:blogger.com,1999:blog-2744263723545918621.post-46669597039243909612009-03-02T13:11:41.719-08:002009-03-02T13:11:41.719-08:00As the originator of the peripheral A-V fistula, I agree in general with your comments.<BR/><BR/>The peripheral A-V fistula is the best method for chronic vascular access. We can anticipate <BR/>10 to 20 to 30 years or more of use from an A-V fistula.<BR/><BR/>However there are instances where an A-V fistula would not be indicated. <BR/><BR/>In patients with multiple or severe co-morbidity that may be life- threatening it would not be indicated. Other means are available for dialysis. After all, an A-V fistulla requires an operative procedure. <BR/><BR/>The A-V fistula is designed for long-term use. Patients requiring short term dialysis are best treated by central lines.<BR/><BR/>The question of closure of an A-V fistula following a successful kidney transplant would depend upon the particular patient. If the fistula is not unsightly we should consider keeping it as a backup. Fistulas are well tolerated and do not detract from the transplant.<BR/><BR/>In general, as in all good medicine, the therapy should be designed to fit the patient and not visa versa. <BR/><BR/>Kenneth Charles Appell, MD<BR/>www.KennethAppellMD.comKenneth Charles Appellhttp://www.kennethappellmd.comnoreply@blogger.com