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VASCULAR ACCESS
Dialysis Fistula/Graft Placement and Management
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Before starting regular hemodialysis session, a patient first needs a vascular access, which is a site on the body where blood will be removed and returned during dialysis. In order to maximize the amount of blood cleansed during hemodialysis, the vascular access should provide high volumes of blood continuously during treatments.
A fistula is a surgically created opening or connection between an artery and vein which are usually separate. An AV fistula is useful because it causes the vein to grow large and strong for easy access to the blood system. It provides adequate flow for dialysis and lasts a long time. However, an AV fistula requires advance planning because it takes a while after surgery for the veins to enlarge enough to use for dialysis.
A surgeon creates an AV fistula by connecting an artery to a vein, usually in the fore-arm. Connecting the artery to the vein causes more blood to flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis treatments easier. The surgery is performed in the operating room under local anesthesia and intravenous sedation and in most cases it can be on an outpatient basis. After the operation to create the fistula, there is usually a wait of several weeks before the fistula is “mature” enough to be used. During this waiting period, a patient may need a special catheter inserted by a radiologist into a large vein in order to be treated with dialysis.
If patients have veins and/or arteries that are too small for creation of a fistula, they can get a vascular access that uses an AV graft (synthetic tube) implanted under the skin in their arm. The tube becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft doesn’t need to mature as a fistula does, so it can be used sooner after placement.
Key Advantages:
- Provides easy and efficient connection to the dialysis machine
- Can function for a long time
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