Dialysis Access Options

Dialysis Access Creation

For patients with kidney failure or end-stage renal disease, hemodialysis is a life-sustaining treatment that filters waste and excess fluid from the blood. Before dialysis can begin, a reliable point of access to the bloodstream must be established — one that can handle the high blood flow rates required for effective treatment, session after session.

At Preferred Vascular Group, our vascular specialists create and manage all types of dialysis access, working closely with nephrologists to ensure each patient receives the access type best suited to their needs and timeline.

Types of Dialysis Access

Arteriovenous Fistula (AV Fistula)

An AV fistula is widely regarded as the gold standard for long-term dialysis access [1]. It is created by surgically connecting an artery directly to a vein, typically in the forearm or upper arm. This connection causes the vein to enlarge and strengthen over time — a process called maturation — creating a robust access point capable of withstanding repeated needle insertions during dialysis.

How a Fistula is Created:

1. Your vascular specialist performs vein mapping (ultrasound evaluation) to identify the best artery and vein for the connection
2. Under local anesthesia, a small incision is made in the arm
3. The selected artery and vein are surgically joined, creating a direct connection
4. The incision is closed and the arm is bandaged
5. Over the following 6-8 weeks, the vein enlarges and strengthens as it receives arterial blood flow

Percutaneous Fistula Creation: In select cases, a fistula can be created using a minimally invasive, catheter-based technique that does not require a surgical incision. This newer approach uses specialized devices to create the artery-to-vein connection from inside the blood vessels.

Advantages:

• Best overall performance and dialysis outcomes
• Longest-lasting access type — can function for years or decades with proper care
• Lowest rate of infection compared to grafts and catheters
• Fewer access-related complications and hospitalizations
• Uses your own blood vessels (no synthetic materials)
• Lower overall healthcare costs

Considerations:

• Requires 6-8 weeks to mature before it can be used
• Not all patients have suitable veins for fistula creation
• May fail to mature in some cases (approximately 20-30%)
• Requires a temporary catheter for dialysis during the maturation period

Arteriovenous Graft (AV Graft)

An AV graft uses a synthetic tube (usually made of PTFE) to bridge the connection between an artery and a vein. Grafts are typically placed when a patient’s own veins are not suitable for fistula creation.

How a Graft is Created:

1. Vein mapping determines the optimal placement location
2. Under local or regional anesthesia, the synthetic tube is surgically implanted
3. One end is connected to an artery and the other to a vein
4. The incision is closed and the arm is bandaged
5. The graft can typically be used for dialysis within 2-4 weeks

Advantages:

• Can be used sooner than a fistula (2-4 weeks vs. 6-8 weeks)
• Provides permanent, long-term access
• Suitable for patients whose veins cannot support a fistula
• The durable synthetic tube can withstand repeated access

Considerations:

• Higher rate of clotting (thrombosis) than fistulas
• Greater susceptibility to infection than fistulas
• May require more frequent interventions to maintain function
• Shorter average lifespan than fistulas

Central Venous Catheter

A catheter is a flexible tube inserted into a large vein in the neck or chest, with the tip positioned near the heart. The external portion of the catheter (called the extensions or lumens) provides direct access for dialysis connection without needle sticks.

How a Catheter is Placed:

1. Local anesthesia is applied to the insertion site
2. Using image guidance, the catheter is inserted into a large vein (typically the internal jugular vein)
3. The catheter tip is advanced to the junction of the superior vena cava and right atrium
4. The catheter is secured to the skin and covered with a sterile dressing
5. The catheter can be used immediately for dialysis

Advantages:

• Can be used immediately after placement — no waiting period
• Suitable for patients who need to start dialysis urgently
• No needle sticks required for dialysis connection

Considerations:

• Highest risk of infection among all access types
• Temporary solution for most patients — intended as a bridge until permanent access matures
• No showers or swimming while the catheter is in place
• Prolonged use can lead to vein narrowing (stenosis) or blood vessel damage
• Requires careful daily care and sterile technique

Choosing the Right Access

The best type of dialysis access depends on several factors, including:

• Your vein anatomy (evaluated through vein mapping)
• How quickly you need to begin dialysis
• Your overall health and medical history
• Your activity level and lifestyle preferences
• Whether you have had previous access procedures

Our vascular specialists will perform a thorough evaluation, including ultrasound vein mapping, and discuss the advantages and considerations of each option to help you make an informed decision.

The Importance of Early Planning

Early referral for access creation is critical. The best outcomes occur when access planning begins well before dialysis is needed:

• AV fistulas require 6-8 weeks to mature, and some may need additional time or intervention
• Early vein mapping identifies the best access site and approach
• Planning ahead avoids the need for emergency catheter placement
• Patients who start dialysis with a mature fistula have better long-term outcomes

If you or your nephrologist anticipates that dialysis may be needed in the coming months, early consultation with a vascular specialist is recommended.

Why Choose Preferred Vascular Group?

Our vascular specialists have extensive experience creating and managing all types of dialysis access. At Preferred Vascular Group, you receive:

• Expert vein mapping to identify the optimal access strategy
• Skilled surgical and percutaneous fistula creation for the best long-term outcomes
• Comprehensive access management including monitoring, intervention, and revision
• Close collaboration with your nephrology team for coordinated care
• Rapid catheter placement when urgent dialysis access is needed
• Eight convenient locations across Georgia and Ohio

Your dialysis access is your lifeline. Our team is committed to providing the expert care needed to create and maintain reliable vascular access for your treatments.

References

1. Lok CE, et al. “KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update.” American Journal of Kidney Diseases, 2020. PubMed
2. Dialysis Fistula. StatPearls, StatPearls Publishing, 2024. NCBI Bookshelf
3. Defined et al. “Increased minimum vein diameter on preoperative mapping with duplex ultrasound is associated with arteriovenous fistula maturation and secondary patency.” Journal of Vascular Surgery, 2014. PubMed