In Reply to ‘Stepwise Attempts on the Forearm Protect Against Exhaustion of Vascular Access Options’

We appreciate the letter from Letachowicz et al1 regarding our article.2 The experiences and perspectives they share provide excellent examples of how the majority of first arteriovenous fistulas (AVFs) created can successfully occur at either the snuffbox or 4 areas of the forearm, as they have accomplished for 97% of their patients.3 Similar efforts to increase lower-arm AVFs are occurring at some US centers.4

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