A patient with end-stage renal disease needs permanent vascular access. Which native arteriovenous fistula is preferred as the first choice when forearm vessels are suitable?

• A Brachiocephalic fistula
• B Radiocephalic fistula at the wrist ✓
• C Brachiobasilic transposed fistula
• D Forearm loop PTFE graft

Explanation

The radiocephalic (Brescia-Cimino) fistula at the wrist is the preferred first access because it preserves proximal veins for future access, has good long-term patency, and low steal risk. It follows the rule of sixes: usable roughly six weeks after creation, diameter about 6 mm, depth under 6 mm. Grafts have higher infection and thrombosis rates, and more proximal fistulas are second-line options.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.