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Abstract
Fashioning a successful angioaccess is essential for the regular hemodialysis in patients with ESRD. Autogenous AVF is much more preferable to synthetic grafts for chronic dialysis access. Maturation of A-V shunt is a complex process but it is an important one ,as it is adisaster to both the patient and doctor to endanger this newly fashioned shunt either by misuse from the dialysis nurse or carless patient or unavoidable factor that may delay shunt maturation or lead to its failure . This project aims at recognition of different factors that may be involved in shunt maturation. 1-Early referral of patients for fistula placement, well before the anticipated date of dialysis initiation; given the long maturation time for fistulas and the frequent need for revision or intervention to promote maturation.Patients who receive fistulas after initiating dialysis frequently have prolonged dependence on tunneled dialysis catheters, with the potential problems of poor blood flow, recurrent thrombosis, and frequent bacteremia. 2-Preoperative mapping to identify the optimal type and location for a fistula; Doppler ultrasound is the preferred method to evaluate the size of the vessels and the central venous system for stenosis, and helps predict the best location for the fistula.