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Literature indicates that the anastomosis size varies from 3 to 15\u2009mm. Nonetheless, common practice favors 6\u201310\u2009mm for distal anastomoses, while the length reduces to 4\u20136\u2009mm when the brachial artery is involved in the elbow or upper arm fistulas. It is advisable to avoid larger arteriotomies to prevent or lessen cardiovascular complications, especially when patients are monitored with access flow assessments and echocardiography for early detection of issues. Considering the high prevalence of elderly patients with cardiovascular risk among incident hemodialysis patients, a more careful approach to managing flow in arteriovenous access is crucial. The anastomotic length should be customized based on the patient\u2019s specific anatomical and physiological conditions, rather than applying a uniform standard.<\/jats:p>","DOI":"10.1177\/11297298251403729","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T07:07:39Z","timestamp":1768547259000},"page":"1832-1837","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["High-flow arteriovenous fistula: Does the anastomosis length matter?"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6752-582X","authenticated-orcid":false,"given":"Carlo","family":"Lomonte","sequence":"first","affiliation":[{"name":"Nephrology Unit, Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Pourchez","sequence":"additional","affiliation":[{"name":"Clinique Ambroise Pare de Bethune-Beuvry, Beuvry, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1330-2820","authenticated-orcid":false,"given":"Mario","family":"Meola","sequence":"additional","affiliation":[{"name":"Sant\u2019Anna School of Advanced Studies, Institute of Life Sciences, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Basile","sequence":"additional","affiliation":[{"name":"Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfz148"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-139x.2000.00039.x"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2007.01.017"},{"key":"e_1_3_2_5_2","volume-title":"From miracle to mainstream: creating the world\u2019s first dialysis organization: early years of Northwest Kidney Centers","author":"Blagg CR.","year":"2017","unstructured":"Blagg CR. 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