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An arteriovenous (AV) graft is a link between an artery and a vein made by inserting graft material between them. The decision to choose an AV graft over another type of access for hemodialysis is individualized based on anatomy and life expectancy, among other factors. AV grafts are constructed by interposing a graft (prosthetic, biological) between an artery and a vein. The main benefit of AV grafts is that they do not require maturation, as AV fistulas do, and that they can be used for hemodialysis in as little as 24 hours after creation, depending on the type of graft used. Prosthetic grafts are widely available on the market and have a long lifespan.

What is Arteriovenous Graft?

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.

Why is AVG Done?

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.

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.
  • You or a close family member will be asked to sign a legal document called a consent form.

During

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.

Complications

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.

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Frequently Asked Questions

1. What is an AV fistula?

An AV fistula is a connection made between an artery and a vein for dialysis access. A surgical procedure, performed in the operating room, is required to join two vessels to create an AV fistula.

2. What is the purpose of AV fistula?

The goal is to allow high blood flow so that as much blood can pass through the dialyzer.

3. How do you check for the presence of an arteriovenous fistula?

Duplex ultrasound is the most effective and common way to detect an arteriovenous fistula in the legs or arms. In duplex ultrasound, sound waves are used to assess the speed of blood flow.

4. Is the dialysis fistula painful?

If a tube was inserted into your windpipe during surgery, you can develop a sore throat. This is usually temporary, but let your care team know if you feel uncomfortable. AV fistula surgery is usually an outpatient procedure, so you go home the same day.

5. How long do AV fistulas last?

AV grafts can be used safely in approximately two weeks, as maturation of the vessels is not necessary. Grafts have a lifespan of about 2 to 3 years, but can often last longer.

6. What is the most common complication of AV fistula?

This is the most serious complication of large arteriovenous fistulas. Blood flows faster through an arteriovenous fistula than through normal blood vessels.

7. Is it a permanent AV fistula?

An AV fistula is a surgically created permanent access located under the skin, which establishes a direct connection between a vein and an artery. Usually, an AV fistula is created in the non-dominant arm. If the veins in your arm are not large or healthy enough to support a fistula, it may be believed in your leg.

8. Is AV fistula surgery high risk?

The creation of an arteriovenous fistula (AFV) for hemodialysis access is a low-risk procedure. It is often time-sensitive as it is essential to avoid central venous catheters (CVCs) and their complications.