Native arteriovenous fistulae (AVF) are the best options for chronic hemodialysis (HD) access. Unfortunately, not every patient fulfils the requirements necessary for this type of vascular access: the artery and the vein implicated in dialysis fistula creation must accomplish some criteria which makes them suitable for this procedure. If these criteria are not fully met, the chances to a successfully intervention and a quick and qualitative maturation of the fistula are dropping [1-5]. An artery that is suitable for AVF creation has an inner diameter > 2 mm, optimal initial flow and elastic walls allowing dilatation to accommodate a supplementary 10 - 20 fold blood flow increase after the AVF is performed [1,2,5-11]. The participating vein must be superficial enough (less than 5 mm from the skin surface), wide enough (a caliber bigger than 2.5 mm) and its walls must allow important dilatation (without fibrosis, injuries, and thickenings). In elderly, diabetics or patients with late initiation of HD some of these demands are frequently absent we need to adapt surgical procedures, taking advantage of any oppor tunity to overcame shortcomings and create a native dialysis access [1,2,5,9].

The prevalence of end stage renal disease (ESRD) is constantly increasing in worldwide population, as is the necessity of renal replacement therapy [1-3]. The improvements in dialysis techniques determined increasing quality and lifetime of dialysis patients and the need for a reliable vascular access that sustains the procedure for long periods of time. On the other hand, the progressive aging of dialyzed population and the emerging complications, as well as the rising prevalence of diabetes as a cause for chronic kidney disease (CKD), hampers the processes of obtaining and maintaining an adequate vascular access [1,4,5].

Chronic kidney disease (CKD) is a worldwide health problem [1,2] affecting between 7 - 10% of young individuals (30 - 64 years old) in Europe [2] and approximately 10 - 18% of the population in the USA [3]. In 2013, in Romania, the prevalence of CKD was approximately 13.1%, meaning about 1,900,000 persons, and 13,899 patients were on chronic dialysis [4].
CKD is associated with increased cardiovascular morbidity, even from early stages [5-8]. Decreased glomerular filtration rate (GFR) is a strong predictor of cardiovascular events, even in the absence of other cardiac risk factors [9]. Risk for cardiovascular disease in CKD patients is 10 - 30 times higher than in non-CKD individuals and mortality from cardiovascular diseases (CVD) accounts for approximately 50% from all causes of death in dialysis population [6,10,11,12]. Predisposing features for developing CVD in CKD patients include both traditional and nontraditional - uremia associated - factors [11,12].