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To the Editor.—
Drs. Ries, Perkins, and Ehrenfeld used saphenous vein arteriovenous fistulas to replace factor VIII in hemophiliacs (226:665, 1973). During the past year, at the M. D. Anderson Hospital and Tumor Institute in Houston, we have been creating arteriovenous fistulas at the wrist in patients with a diagnosis of acute leukemia. These patients often present a problem similar to that in hemophiliacs. With continuous intravenous chemotherapy in the face of need for frequent venipunctures to monitor blood chemistries, these patients rapidly "run out of veins."The search for a suitable vein through which to administer medication then becomes an agonizing experience for the patient and a frustrating one for the physician. By creating these fistulas as soon as the diagnosis is made, we are able to establish suitable fistulas in the wrist before the veins have become thrombosed. We have not found it necessary to use saphenous vein
Steckler RM. Surgically Created Arteriovenous Fistulas. JAMA. 1974;227(6):657. doi:10.1001/jama.1974.03230190049017
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