Arteriovenous Shunt or

Arteriovenous (Bridge) Fistula

Definition

Establishment of a direct connection between an artery and a vein. A communicating prosthetic loop
between an artery and a vein (shunt) or a direct communication between an artery and vein (fistula).

Discussion

The procedure is performed to provide easy access for venipuncture with a large-bore needle
for purposes of renal dialysis or infusion chemotherapy. Arteriovenous (AV) shunts or arteriovenous
(bridge) fistulas involve the creation of a connection between an artery and a vein. When patients are in
the late stages of renal disease, an arteriovenous shunt (Cimino shunt) is created for them in
anticipation of their receiving dialysis. An anastomosis of the artery and vein form an internal
connection (side to side, side to end, or end to end). The anastomosis on the venous side bulges under
the greater pressure from the artery.The site of the venous dilatation formed at the anastomosis site
thickens over the period of a few weeks. When the walls of the vein become thick (like arteries), the
vein is strong enough to endure the repeated venipuncture required by dialysis.

Bridge fistulas are the creation of a connection between an artery and a vein by means of a
bridge. A bridge may be created from a saphenous vein graft, an umbilical vein graft, or a bovine artery
prosthesis (usually enzymatically treated) or PTFE (Teflon) graft.A modification of the PTFE graft has
tapered ends.The size of the bridge, whether straight or curved, depends upon the proximity of the
vessels to each other.