Dialysis is a lifesaving treatment for patients with chronic kidney disease, kidney failure, or end-stage renal disease. While the treatment is not a cure and can only do a portion of the work of healthy kidneys, it is an excellent option that can prolong the life of patients and offer hope while waiting for transplants.
For the process to work, patients must undergo surgery to place a shunt between an artery and a vein. The two most common options are a graft or a fistula. When weighing the options of a dialysis graft vs. a fistula with your doctor, you must consider your condition, blood flow, and the longevity of the option.
What Is a Dialysis Graft Vs. a Fistula?
The two shunt types are a form of arteriovenous connection, referring to a connection point between an artery and a vein. The arteries transport oxygen-rich blood from your heart and lungs throughout your body. Veins carry oxygen-depleted blood on the return to the heart and lungs.
Surgeons typically place a graft or a fistula in the arm, intending to direct blood from the artery to the vein. The redirection increases the blood flow and pressure through the vein, which is essential to meeting the flow rate requirements of the dialysis machine for cleaning, filtering, and removing excess fluid from the blood.
Each shunt type has its advantages and disadvantages. Your surgeon and primary care physician can help you decide which option is right for your treatment needs.
AV Graft
An AV graft is a deliberate connection between the brachial or radial arteries and the basilic, cephalic, or brachial veins using a soft, rubbery prosthetic tube in a straight or looped configuration. The graft is the most common prosthetic used for chronic hemodialysis.
As you consider a dialysis graft vs. a fistula, the primary concern is usually the surgery. Both surgeries are outpatient and only use a local anesthetic, allowing easy and rapid recovery. Still, the graft surgery is less involved and requires less recovery time and biological adaptation, so the patient can begin using it within two to four weeks after placement.
Also, the graft is a dialysis solution for patients with small or weak veins that are not suitable for fistulas. Still, AV grafts have many disadvantages, including the use of synthetic material in the body and an increased risk of aneurysms, blood clots, and infections.
Grafts require constant attention and upkeep to reduce risks. They also last, on average, two to three years before they close or restrict blood flow to the dialysis machine. Your surgeon and renal care specialist can help you weigh the pros and cons of this option.
AV Fistula
The fistula usually comes out on top when comparing a dialysis graft vs. a fistula. Like an AV graft, an AV fistula connects an artery to a vein to prepare for dialysis. Unlike AV grafts, the fistula does not use a prosthetic; it is the surgical connection of a vein and an artery that eliminates some complications and risks associated with a graft.
Medical professionals consider the AV fistula the best choice for vascular access because it eliminates artificial materials while still providing good blood flow for dialysis. Also, the surgery reduces the future risks of clotting and infection. The form of vascular access also provides a solution for patients who thought they had exhausted permanent access sites.
A fistula surgery is an outpatient procedure like graft surgery, but the recovery time is longer. Because the fistula is a permanent part of the body, your body needs to heal, adapt, and mature, which can take several weeks or months. Patients with acute renal failure may need temporary vascular access points until the fistula is strong enough for cannulation.
A fully mature fistula can last decades, making it superior to grafts. That said, some fistulas do not mature, requiring repeat surgeries. Also, stenosis is a common problem with the procedure, which can lead to blood flow decreases and possible blood clots. Still, in the dialysis graft vs. fistula debate, the fistula is a better option for most patients.
Is a Fistula or Graft Better for Dialysis?
A fistula is the first choice for dialysis because of its longevity and reduced risks of infection and clotting. The graft is the second choice for access. If you already have a graft or are working with a temporary catheter, you can ask your dialysis care team if a switch is possible. Sometimes, your team may recommend the transition to a fistula if the graft isn’t functioning well or if you need to upgrade from a temporary shunt to something more permanent.
How Do You Care for a Fistula or Graft?
According to the National Kidney Foundation, fistulas and grafts require similar care. You want to check the area for redness, swelling, or excess warmth after and in between treatments. Also, check for the beginning of a pimple on any area of your access point. These issues can indicate the beginning of an infection.
Also, if the dialysis team hasn’t done so already, you can ask them to rotate the needle sites. Rotating needle sites is a cannulation technique that can help prolong the life of your vascular access site by placing needles in different locations from your last treatment.
Who Can Help You Compare a Dialysis Graft Vs. a Fistula?
The choice between a dialysis graft or a fistula is challenging to make alone. As a patient, you rely on the medical expertise of your primary care physician, kidney care team, and surgical team. There are many considerations that go into the vascular access selection process, including your condition, age, and vascular system.
Arizona Premier Surgery is here to help. Our team of vascular surgeons can walk you through the pros and cons of a dialysis graft vs. a fistula and explain why one option is better for your dialysis treatments over the other. Whether you are at the beginning of your dialysis journey or experienced with the process, contact Arizona Premier Surgery to schedule a consultation.
Sources:
https://www.kidney.org/atoz/content/hemoaccess
https://www.sciencedirect.com/topics/nursing-and-health-professions/arteriovenous-graft
https://www.azuravascularcare.com/infodialysisaccess/faqs-dialysis-access/
https://www.yalemedicine.org/conditions/preparing-dialysis-av-fistula
https://www.astraveinvascular.com/av-fistula-vs-av-graft/
https://www.kidneyfund.org/treatments/dialysis/about-vascular-access
http://www.laminatemedical.com/2020/03/08/differences-between-av-graft-and-fistula-advantages-and-disadvantages/
https://navicenthealth.org/service-center/atrium-health-navicent-heart-vascular-care/av-graft-or-fistula-for-permanent-dialysis-access