Arteriovenous (AV) fistula creation is a procedure that establishes a durable vascular access point for haemodialysis in patients with chronic kidney disease or end-stage renal failure. It involves creating a connection between an artery and a vein, allowing increased blood flow into the vein so that it can support the high-volume access required for dialysis.

There are two main approaches:

• Surgical AV fistula creation: This traditional method involves making a small incision, typically in the forearm or upper arm, to connect a vein directly to a nearby artery. The vein gradually enlarges and strengthens, making it suitable for repeated needle use during dialysis. Surgical fistulas remain the gold standard due to their long-term durability and low infection risk.

• Endovascular AV fistula creation (endoAVF): A newer, minimally invasive technique that uses catheters and energy-based devices (e.g., heat or radiofrequency) to create a fistula from within the blood vessels, without the need for open surgery. It is performed through small punctures under ultrasound and fluoroscopic guidance.