What are the Two Options for Dialysis Access?

Blog Post
By South Valley Vascular
January 3, 2023

During dialysis treatments, surgeons create something called vascular access that can remove and return blood during dialysis. There are two primary options for this kind of vascular dialysis access: arteriovenous (AV) fistula and AV graft. The AV fistula is a connection made by a vascular surgeon between an artery and a vein (thus arteriovenous). The AV graft, on the other hand, is a looped plastic tube connecting the artery to the vein. The third type of vascular access, the venous catheter (a tube inserted into a vein), is for short-term use only. A dialysis catheter is not ideal for long-term hemodialysis, it can lead to blood clots, infections, or vein scarring. However, there may still be cases where it’s recommended.

All three types of dialysis access have potential side effects like infection and low blood flow that may complicate treatment. However, both the AV fistula and AV graft have benefits associated with long-term dialysis treatment. We’ll be looking at these options for long-term dialysis treatment.

Dialysis Access with an AV Fistula or AV Graft

AV Fistula

Most healthcare providers’ first recommendation for dialysis access options is typically the AV fistula. A vascular surgeon typically places an AV fistula in the forearm or upper arm. The extra pressure and blood flow to the vein increase its size and strength. This makes the vein an easy and reliable access point for dialysis. Untreated veins would not be able to handle repeated needle insertions the same way as a fistula. The fistula lasts longer than other types of dialysis access and is less likely to get infected.

Before AV fistula surgery, the surgeon may perform a vessel mapping test. This test uses ultrasound to evaluate the vessels. The procedure itself can usually be performed as an outpatient procedure. The dialysis access procedure may require an overnight stay in the hospital, however, many patients go home immediately afterward. After two or three months for the AV fistula to mature, it’s ready to use for dialysis access.

AV Graft

If the fistula does not mature, then the AV graft is typically the second option. Like the AV fistula surgery, it’s typically an outpatient procedure, with only local anesthetic required. The AV graft is ready for use two to three weeks after surgery. An AV graft is more likely than an AV fistula to have infection or clotting problems. Repeated clots can block the flow of blood through the graft. If the graft is regularly cleaned and well taken care of, it can last for several years.

Steps for Home Dialysis Care

Home dialysis care begins with the patient taking care of and protecting their vascular access. They should get checked regularly by their healthcare provider for signs of infection or problems with blood flow. This should be done even if the patient is inserting their own needle. Patients should keep the access site clean at all times and use it only for dialysis. Avoid bumping or cutting the access, and check the thrill (the rhythmic vibration that can be felt over the access site) every day. 

Look for any signs of infection, including redness, tenderness, or pus. Don’t use a blood pressure cuff on the access arm or wear any jewelry or tight clothes. When you sleep, make sure the access arm is not under the head or body to reduce the risk of damage. Similarly, avoid lifting heavy objects or putting stress or pressure on the access arm.

Consult a Dialysis Expert

South Valley Vascular is here to meet all the vascular needs of the South San Joaquin Valley area. Our vascular specialists will help you successfully navigate the dialysis process. South Valley Vascular’s board-certified specialists will provide the highest level of vascular care. Whether you’ve been recently diagnosed or are considering changing providers, we’re here for you. Please call or visit us today for more information.