You have been diagnosed with ESRD ( End-Stage Renal disease )  and to begin dialysis, access is required.  One of the alternatives is an arteriovenous (AV) graft. According to the 2015 United States Renal Data System report, within 1 year of hemodialysis initiation, roughly 15% of people on dialysis were using a graft.

What is an AV graft?

An arteriovenous (AV) graft is a kind of access used for hemodialysis.

Where is an AV graft placed ?

The graft is generally placed in the arm, but may be placed in the leg if important.  An AV graft is the link  of a vein and an artery that uses a hollow, synthetic tube (the actual “graft”).  One end of the tube is related to an artery and the other end of the tube is related to a vein.  This relation results in blood flowing from the high flow, high pressure artery through the graft and into the low flow, low pressure vein.  As an outcome the blood flow through the graft gives a flow rate that will send  enough blood to provide an adequate hemodialysis treatment.

Why do you need a graft for dialysis?

Dialysis fistula/graft declotting and interventions are minimally invasive techniques conducted to enhance or restore blood flow in the fistula and grafts placed in the blood vessels of dialysis patients. Dialysis is a procedure used to treat patients whose kidneys are not functioning properly.

What is the process for placing an AV graft?

Local anesthesia is administered to the region selected for graft placement. The doctor makes two small incisions in order to access the artery and vein. Next, one end of the graft is surgically linked  to the artery, the other end is connected to the vein. Once located, blood now flows from the artery, through the graft and into the vein. This permits needles to be placed into the graft for hemodialysis.

How long do AV grafts last?

AV grafts can be safely used in about two weeks, as no maturation of the vessels is essential. Grafts have a lifespan of about 2 to 3 years but can often last longer.

What does an AV graft feel like?

Once your graft has been positioned, you’ll be able to feel it beneath your skin. You will feel a vibration, or thrill if you put  your fingers over the graft. This vibration is a proof of the blood flowing through your graft. This vibration, or thrill, is an essential indicator of how well your graft is functioning.

Advantages of an AV graft:

An AV graft gives a solution for small or weak veins.

An AV graft can be used as quickly as two to four weeks after placement.

AV graft surgery is generally done on an outpatient basis, under local anesthetic, facilitating for a rapid and easy recovery.

Are you a candidate for an AV graft?

While an AV fistula is considered the source of selection  by most people in the vascular field, an AV graft is a close second and may be the best alternative for certain people. For example, if your veins are too small for a fistula to properly develop or if your veins are not strong  you would be a better candidate for an AV graft.

If you are on dialysis or you may be beginning in the future, you may be a candidate for AV graft placement. If you understand you may be a candidate for a graft or have questions about whether this access type is right for you, be sure to talk  with your  physician.

Recovering from the AV graft placement process

After the procedure, your physician will advise you to keep your arm elevated, either by raising it or strengthening it with a pillow to decrease swelling and pain at the access site. You may feel some slight trouble or swelling in your arms for a few days, but this is not unusual. If you are able to feel a slight vibration (thrill) through your bandage this implies your graft is working properly.

Difference between an AV fistula and an AV graft

The fistula suppresses clotting and infection. An AV graft (occasionally called a bridge graft) is an indirect relation between the artery and vein, most commonly a plastic tube is used, but donated cadaver arteries or veins can also be used.