AV Access for Dialysis Patients

Options for Dialysis

There are two ways to replace the function of the kidney: peritoneal dialysis and hemodialysis. Only your nephrologist knows which is the best option for you. At Pacific Cardiovascular & Vein Institute, we are proud to provide all the surgical procedures that allow your nephrologist to successfully dialyze you.

What is AV Access?

If your nephrologist has chosen hemodialysis for you, we at Pacific Cardiovascular & Vein Institute can help. Hemodialysis requires getting hold of a sufficient amount of blood in order to wash it in a dialysis machine. There are three options to access this large amount of blood: dialysis catheter, arteriovenous fistula (AV fistula), or arteriovenous graft (AV graft).

  • A dialysis catheter is a large IV tubing that is inserted into one of the large veins in your neck of chest, and placed very close to the heart. The catheter exits from your chest and is easily covered up by your clothing. The benefit of catheter over the other options is that it can be used for dialysis as soon as it is successfully placed. However, catheters do not have longevity and are frequently complicated by clotting, insufficient dialysis, and infections. Catheters are recommended only for temporary usage in the order of months, and should be taken out as soon as one of the other options become available.
  • Arteriovenous fistulas (AV fistulas) represent the best option as AV access. We make small incisions to connect your artery to your vein, usually near the wrist or the elbow. Arteries are naturally deep while veins run near the surface. Once we connect the artery to the vein, the robust arterial flow is now running through the superficial vein near the surface. The dialysis technician now has easy access to a lot of blood flow near the surface, and inserts IVs into the fistula to dialyze you. The AV fistula has been shown to last the longest and has the least infectious and other complications. It is currently recommended to be used on as many patients as possible. However, not every patient has the suitable veins, and the AV fistula needs time to “mature” and become ready. It may also require multiple small procedures to get the AV fistula ready for usage and to maintain its health. We at Pacific Cardiovascular & Vein Institute will search all your available veins and perform all the necessary procedures to get you a working AV fistula and keep it working.
  • Arteriovenous grafts (AV grafts) are created by connecting your artery to a large deep vein in your arm or leg. We reserve grafts for patients whose superficial veins are not suitable for fistula creation. Compared to the catheter, AV grafts have lower risk of complications and can last longer. It typically takes 2-3 weeks for a graft to become ready for dialysis. Like fistulas, it may also take a few procedures to create and maintain a graft in working condition.