Vascular Access for Dialysis

A fistula usually needs time to mature before it can be used regularly for dialysis. During this period, the healthcare team monitors its development and blood flow.

2. Arteriovenous Graft

An AV graft uses a synthetic or biological tube to connect an artery and vein when the patient's veins are not suitable for creating a fistula.

The graft provides a pathway through which blood can flow during haemodialysis. It may be considered when an AV fistula cannot be created or is unlikely to mature adequately.

The choice between a fistula and graft depends on vessel characteristics, medical conditions, previous access history, dialysis requirements, and the patient's overall treatment plan.

3. Central Venous Catheter

A dialysis catheter is a flexible tube inserted into a large vein, commonly in the neck, chest, or another appropriate location. It can provide relatively rapid access and may be particularly useful when dialysis needs to begin before a fistula or graft is ready.

However, long-term catheter use has important risks, including bloodstream infection, clotting, catheter dysfunction, and problems with central veins. For this reason, an AV fistula or graft is generally preferred for long-term haemodialysis when clinically appropriate.

How Is Dialysis Vascular Access Created?

Before creating permanent vascular access, the doctor evaluates the patient's medical history and examines the blood vessels. Imaging such as vascular ultrasound may be used to assess vessel size, blood flow, and suitability for access creation.

For an AV fistula, the surgeon connects a suitable artery and vein. Over time, the vein adapts to the increased blood flow and becomes suitable for repeated cannulation.

For an AV graft, a specially designed tube is placed beneath the skin to connect an artery and vein.