What is the preferred vascular access in patients undergoing chronic hemodialysis?

The preferred vascular access for patients undergoing chronic hemodialysis is typically the brachiocephalic AV fistula. This type of fistula is created by connecting the brachial artery to the cephalic vein in the arm, which leads to optimal blood flow characteristics and a lower risk of complications over time compared to other options.

Using a native AV fistula like the brachiocephalic version has several advantages. It generally has a longer durability than grafts or other forms of access and is less prone to infections. It also provides adequate blood flow rates necessary for effective dialysis treatment.

Other options, such as the radial-cephalic AV fistula, can be used but may not always provide the same flow rates or be as reliable over the long term. Meanwhile, transposed brachiobasilic fistulas and polytetrafluoroethylene grafts are often considered second-line options because they may have a higher risk of complications and might not last as long as a native AV fistula.

Thus, the brachiocephalic AV fistula's reliability, lower complication rates, and suitability for long-term use make it the preferred choice in chronic hemodialysis patients.