Arteriovenous shunt and its conversion to arteriovenous fistula: A relook

Vascular access is a significant economic, sur­gical and logistical consideration for patients as well as health-care givers of patients with chronic kidney disease. Of the traditional tem­porary accesses, the subclavian catheters have gone into disrepute worldwide. In a country like India, where most often, nephrologists see the patient for the first time in CKD stage-5 or even stage-6 due to late referral, it becomes mandatory to initiate dialysis through a tempo­rary vascular access. [1] Even in the United States, 60% of the patients starting dialysis do so with a central catheter.