Fistulas are the preferred vascular access for long-term dialysis patients. It is usually placed in the:

Fistulas are indeed the preferred vascular access for long-term dialysis patients primarily because they provide reliable and durable access to the bloodstream, which is essential for hemodialysis. The forearm is typically chosen for the placement of arteriovenous (AV) fistulas because it offers several advantages.

Placing a fistula in the forearm allows for an easier surgical procedure with a lower risk of complications such as infection and thrombosis compared to other locations. The veins in the forearm are generally more accessible and of suitable size to provide effective blood flow during dialysis sessions. Additionally, using the forearm helps to preserve upper arm access sites for potential future procedures, which is important for long-term care.

The preference for the forearm is based on maximizing the longevity and functionality of the fistula, which is vital for patients who are on dialysis for extended periods. Each patient's individual vascular anatomy and overall health condition would also be evaluated, but the forearm remains the standard site due to its favorable characteristics.

In contrast, sites like the neck or calf might not offer the same reliability or ease of access for long-term use. The upper arm can be an option, but it is generally used when forearm access is not available or feasible.