Snuffbox Radiocephalic Arteriovenous Fistula Creation for End-Stage Kidney Disease
Brett J. Salomon, MD1; Christopher Holden-Wingate2,3; Mohamad A. Hussain, MD, PhD1,2; C. Keith Ozaki, MD1
1Mass General Brigham
2Harvard Medical School
3University of Illinois College of Medicine
The snuffbox arteriovenous fistula (SBAVF) is a distal-first dialysis access strategy connecting the posterior branch of the radial artery and cephalic vein within the anatomical snuffbox to preserve proximal vascular sites for patients requiring long-term hemodialysis (HD). This low-flow forearm fistula, which represents only 4% of forearm access creations in a contemporary large registry, provides significant clinical advantages over high-flow alternatives. These benefits include a significantly lower risk of high-output heart failure (HOHF) and negligible rates of access-related hand ischemia (ARHI). Contemporary literature confirms that SBAVF offers primary and secondary patency rates comparable to wrist AVFs at 18 months, supporting a “snuffbox first” approach for eligible candidates.
This case details successful SBAVF creation in a 38-year-old male with end-stage kidney disease (ESKD), which was selected to maximize vessel preservation given his prolonged expected duration of HD. Postoperatively, the patient was discharged without complication and subsequently cleared to trial HD after successful maturation. Although it is common for SBAVFs to require adjunctive procedures and more time to achieve maturation, long-term durability (5–9 years) remains outstanding, reinforcing the value of this technically precise procedure as a safe and durable primary access option.