JVA ISSN 1129-7298 J Vasc Access 2017; 18 (6): 451-463 © 2017 Wichtg Publishing REVIEW aging (10), cardiovascular disease (11, 12) and diabetes (13) among patents with chronic kidney disease (CKD) has resulted in a more challenging surgical constructon of natve AVF than previously. Intensive eforts to promote AVF creaton, despite the presence of marginal vessels, have increased primary fail- ure rates, namely, the rate of AVF not suitable for HD due to thrombosis and/or lack of maturaton (14). Recent studies have estmated that primary AVF failure and 1-year primary patency rates are approximately 23%-37% and 40%-60%, respectvely (15, 16). To date, there is an accumulatng evidence that other conditons such as late referral, lack of dedicated vascular ac- cess team, severe morbidity and lack of preoperatve vascular mapping may contribute negatvely to successful placement, use and survival of natve AVF. Here, we review guidelines and clinical evidence regarding preoperatve management of autogenous fstula with the goal of promotng placement of a long-term functoning natve AVF and preventng severe com- plicatons associated with its creaton. With this aim, we pro- pose the following fve-step preoperatve program: 1. Management of patients with advanced CKD 2. Management of preoperative risk factors for AVF failure 3. Planning of native AVF 4. Assessment of patient eligibility 5. Preoperative vascular mapping Management of patents with advanced CKD In 1993, the Natonal Insttutes of Health Consensus De- velopment Conference on Morbidity and Mortality of Dialysis DOI: 10.5301/jva.5000771 Preoperatve management of arteriovenous fstula (AVF) for hemodialysis Gaetano Alfano 1 , Francesco Fontana 1 , Mario Iannaccone 2 , Patrizia Noussan 2 , Gianni Cappelli 1 1 Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena - Italy 2 Cardiology Division, San Giovanni Bosco Hospital, Turin - Italy Introducton It has been over 50 years since, in 1966, Brescia, Cimino, Hurwich and Appel published their memorable paper “Chronic hemodialysis using venipuncture and a surgically created ar- teriovenous fstula” (1). With this report, the authors shared their positve experience about the use of arteriovenous fstula (AVF) as vascular access for hemodialysis (HD). Creaton of AVF represented a milestone in the development and applicaton of dialysis treatment because it reduced rate of complicatons given by external prosthetc loops and central vein catheters (CVCs) (2). Afer half a century, AVF stll represents the favor - ite vascular access to provide HD in terms of access patency (3), patent mortality (4, 5), morbidity (6, 7) and health cost (8) compared to arteriovenous graf (AVG) and CVC. In 1997, the Natonal Kidney Foundaton (NKF), through the vascular access guidelines of Kidney Disease Outcomes Quality Initatve (KDOQI) ranked AVF as the best available access for HD and recommended its creaton in most patents (9). Unfor- tunately, increasing prevalence of poor-quality vessels due to ABSTRACT Natve arteriovenous fstula (AVF) is the favorite access for hemodialysis (HD). The Natonal Kidney Foundaton’s Kidney Disease Outcomes Quality Initatve (KDOQI) recommends its creaton in most patents with renal failure. Unfortunately, intensive eforts to promote natve AVF in patents with marginal vessels have increased the rate of primary fstula failure. A non-functoning fstula prompts the use of central venous catheter (CVC) that, unlike AVF, has been associated with an increased risk of morbidity and mortality among patents receiving HD. We believe that successful and tmely AVF placement relies on the development of a multdisciplinary integrated preoperatve program divided into fve stages: (i) management of patents with advanced chronic kidney disease (CKD), (ii) management of preoperatve risk factors for AVF failure, (iii) planning of natve AVF, (iv) assessment of patent eligibility and (v) preoperatve vascular mapping. Focusing specifcally on natve AVF, we review scientfc evidence regarding preoperatve management of this vascular access in order to favor constructon of long-term functoning fstula minimizing development of severe complicatons. Keywords: Natve AVF, Preoperatve management, Vascular access Accepted: June 2, 2017 Published online: October 11, 2017 Corresponding author: Gaetano Alfano University Hospital of Modena Via del Pozzo, 71 41124, Modena, Italy gaetano.alfano.md@gmail.com