Understanding Dialysis Access. Educational Video

What is dialysis access? What is an arteriovenous fistula or arteriovenous graft (AVF/AVG)?

Patients who suffer from kidney disease may eventually find themselves meeting the threshold which calls for dialysis. At this point, their kidney function has diminished and is no longer filtering the blood at a healthy, normal rate. This leads to severe kidney disease symptoms which, without dialysis, will lead to severe and catastrophic outcomes.

A chronic kidney disease (CKD) patient may be referred to a vascular surgeon prior to their referral to dialysis. Why? If a patient chooses hemodialysis as their next step, it is crucial to have their dialysis access created with plenty of time to heal and mature. The maturing process may take up to three months, or possible longer, until the fistula is ready for use. While dialysis may begin without a fistula, the venous catheter option has associated risks such as infection and restricts the patient from showering.

What is an Arteriovenous Fistula?

An Arteriovenous Fistula (AV fistula, AVF) is an artificial connection between a native artery and a vein, usually in your arm, for hemodialysis treatment. Veins normally do not have enough blood flow nor are they large enough to accommodate the needles needed during dialysis. Arteries, however, have a high blood flow and are large but have rigid vessel walls and are much deeper beneath the skin. When an AVF is created, an artery is connected to a vein which allows the connected vein to have higher blood flow and will eventually enlarge; making it the perfect conduit for hemodialysis.  

What is an Arteriovenous Graft?

An Arteriovenous Graft (AV Graft, AVG), which uses a synthetic tube to connect a vein to an artery for dialysis access. Those who have smaller veins may not be a candidate for a native AVF creation, and so a graft is the alternative. The benefit of having an AV graft placed is that they take less time to be deemed ready for use during dialysis. However, grafts have a higher risk of infection compared to a native AVF.  

What is a Venous Catheter?

A Venous Catheter (central venous catheter, perm cath) is always an option when AVF and AVGs options are not available to the patient at that point in time. The venous catheter is a plastic tubing which is inserted in through the skin, usually in the neck and in through the jugular vein. Because this type of dialysis access involves a foreign body being placed into the body and remains exposed outside the body, it inherently carries a higher risk of infection. Patients and their caretakers must take care to keep the catheter clean and dry.

Watch our Education Video on Dialysis Access

For more detailed information, watch Dr. Bradley Hill explain the different type of dialysis access in this video.