What are the potential complications of Arteriovenous Grafts (AVGs)?

AVGs are more prone to infection and clotting compared to AV fistulas. They may require more frequent monitoring and maintenance to prevent complications.

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13-07-2024 Team Medicover Procedure

What is Arteriovenous Graft?

Q: What is an Arteriovenous Graft (AVG)?

An Arteriovenous Graft (AVG) is a synthetic tube typically made of biocompatible material (such as PTFE or polytetrafluoroethylene) that connects an artery to a vein, creating a pathway for hemodialysis.

An arteriovenous graft (AVG) is a procedure that uses a graft to link an artery to a vein. A graft is a tube made of plastic.

If your artery and vein cannot be linked directly for hemodialysis, you'll need an AVG.

The AVG is usually placed on the non-dominant arm. For example, if you are right-handed, the AVG will be placed on your left arm.

The blood will flow out and return to the AVG after the hemodialysis machine cleans it.

Arteriovenous Graft for Dialysis

Most doctors prefer AV fistula to grafts or catheters for several reasons.
It tends to offer the most blood flow, so patients are on dialysis and feel uncomfortable for the shortest amount of time possible.
Because they are a natural part of the body, they last much longer and are less expensive to maintain than the graft or catheter.
They also offer a much lower risk of infection or clotting, which means fewer complications for patients already dealing with regular dialysis.
Some physicians believe that those who already have an AV graft or an implanted catheter may be good candidates for an AV fistula and should be reassessed.
A strong initiative has begun to persuade doctors and patients alike to choose an arteriovenous fistula.

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Arteriovenous Graft Procedure

The Day of Your Surgery

Ask your doctor before taking any medicine on the day of your surgery. Bring a list of all the medications you take, or your pill bottles, to the hospital.
Doctors will check that your medicines do not interact badly with the medicine you need for surgery.
Doctors can insert an intravenous (IV) tube into your vein. Usually, a vein is chosen in the arm. Through the IV, you may be given fluids and medicine.
An anesthesiologist will talk with you before your surgery. You may need medicine to keep you asleep or to numb an area of your body during surgery.
Tell your doctors if you or someone in your family has had a problem with anesthesia in the past.

During the Surgery

During surgery, you will be given anesthesia to keep the pain at ease. Between the blood vessels, an incision will be made.
Tools will be used to separate the vein and artery from nearby nerves and tissues. Clip-on tools will be placed in both blood vessels to stop blood flow.
Incisions will be made in the blood vessels where the graft (plastic tube) will be placed. The graft would be inserted into the artery on one end and the vein on the other.
The graft will be secured to the blood vessels with stitches. The clip-on tools will be removed and the blood flow in the blood vessels will be checked.
The graft will be placed close to the skin and the skin will be closed with stitches.

After The Surgery

You will be taken to a room where you will rest until you are fully awake. Doctors will keep a close eye on you for any issues.
Don't get out of bed until your healthcare provider says it's okay. When your healthcare provider sees that you are okay, they will move you to your hospital room.

Arteriovenous Graft vs Fistula

The choice between an AV graft and an AV fistula depends on several factors, including the patient’s vein quality, overall health, and how quickly dialysis is needed.

Here's a quick comparison to help understand the differences:

Feature	AV Graft	AV Fistula
Material	Synthetic (e.g., PTFE)	Patient’s own blood vessels
Maturation Time	2-3 weeks	6-12 weeks
Lifespan	2-3 years	Many years
Infection Risk	Higher	Lower
Complications	More frequent (clotting, infection)	Fewer
Suitability	Patients with smaller veins	Patients with good vein quality

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Both AV grafts and AV fistulas provide crucial access for dialysis, each with its own set of benefits and drawbacks.
The decision should be made collaboratively between the patient and their healthcare team, considering the patient's specific medical condition and needs.
Understanding these options can empower patients to make informed decisions about their dialysis care.

Complications of Arteriovenous Surgery

If left untreated, an arteriovenous fistula can cause complications, some of which can be serious. These include:

Heart Failure

This is the most serious complication of large arteriovenous fistulas. Blood flows faster through an arteriovenous fistula than through normal blood vessels.
As a result, your heart pumps harder to compensate for the increased blood flow. Over time, the increased workload on your heart can interfere with how your heart works and lead to heart failure.

Blood Clots

An arteriovenous fistula in the legs can lead to blood clots, which could lead to deep vein thrombosis, a painful and life-threatening condition if the clot travels to the lungs (pulmonary embolism). A stroke can occur depending on where your fistula is located.

Leg Pain

An arteriovenous fistula in your leg can cause pain in your leg (claudication) or it can make the pain you already have worse.

Bleeding

Arteriovenous fistulas can cause bleeding in your gastrointestinal system.

Frequently Asked Questions

An Arteriovenous Graft is a synthetic tube typically made of biocompatible material (such as PTFE or polytetrafluoroethylene) that connects an artery to a vein, creating a pathway for hemodialysis.

AVGs are used when a patient's blood vessels are not suitable for creating a natural AV fistula. They provide a stable and reliable access point for hemodialysis treatments.

Surgeons create an AVG by surgically connecting an artery to a vein using the synthetic graft material. This connection allows for repeated access to the bloodstream for hemodialysis.

AVGs can be used in patients with minor or weak blood vessels that are not suitable for creating a fistula. They can be placed more quickly than fistulas and may be used sooner after placement.

AVGs are more prone to infection and clotting compared to AV fistulas.

The lifespan of an AVG varies widely among patients. Some may last for several years with proper care, while others may need replacement sooner due to complications or wear.

Yes, an AVG can often be used for hemodialysis shortly after surgery once it has healed and adequate blood flow has been established.

Follow your healthcare provider's instructions for keeping the AVG site clean and dry. Monitor for signs of infection or clotting and report any changes to your healthcare team promptly.