Dialysis Access – AV Fistula & Graft

What Is a Dialysis Access?

When your kidneys fail, your body is unable to clean and filter your blood. Electrolyte levels, such as potassium and phosphorous, can become dangerously high. When kidney function falls below a certain threshold, dialysis is needed.

If it appears that dialysis will be needed in the future, a dialysis access is established.


What Is an AV Fistula?

An AV fistula is when a piece of a vein from your arm or leg is sewn into a nearby artery. This allows the sewn-in vein to enlarge and become thicker, like an artery.

With the lowest risk of infection, this is procedure is considered the best option.

What Is an AV Graft?

An AV graft is when a prosthetic graft is sewn in between an artery and vein in your arm or leg. AV grafts tend to close more quickly and are more prone to infection because they are not formed from natural tissue.

This option is preferred when a patient’s veins are too small for an AV fistula.


Your dialysis access surgeon will explain the procedure and perform a physical exam, focusing on the arm or leg selected.

In the operating room, your arm or leg is cleansed with an antiseptic solution and sterile drapes are placed around it. An incision is made between the artery and vein, and the vessels to be joined are prepared.

If creating a fistula, your surgeon may divide the vein and sew one end to the side of the artery, or may sew the two vessels side-to-side without dividing the vein.

If a graft will be placed, your surgeon will sew it between the artery and vein.

The incision in your arm or leg will be closed, and a sterile dressing will be applied.


How Will I Know If I Need AN AV Graft Or An AV Fistula?

An ultrasound scan is used to map your veins and see if they are large enough for an AV fistula. If not, an AV graft will be needed.



What Are the Possible Risks of the Procedure?

The most common complication is bleeding. Generally, this is noticed and taken care of before you go home.

Contact your dialysis access surgeon immediately if:

  • You notice swelling or a saturated bandage
  • Your hand or leg becomes very cold or numb


Before the Procedure

How to Prepare

  • Avoid having blood drawn from veins in the selected arm or leg
  • Do not eat, drink, or chew anything 8 hours before your procedure. This includes gum, mints, water, etc.


After the Procedure

What to Expect After Dialysis

Once you begin dialysis, inspect the access site regularly for bleeding or signs of infection, such as redness or warmth.

Important things to note:

  • The vein will enlarge and it should be easy to feel a vibration
  • Avoid sleeping on the affected arm or leg
  • Avoid constrictive clothing over the site
  • Most surgeons recommend a healing period before your first dialysis treatment
    • 2 to 3 months for a fistula
    • 4 weeks for a graft


Please note, a slight coolness in the affected hand or leg is common. This happens because some of the blood that was supplying the hand or leg is being redirected. Squeezing an old tennis ball or racquetball in your hand can help your body readjust.



When you place your hand over the fistula or graft, you should easily feel a vibration when vibration changes. If the vibration stops or becomes a pulsation, contact your dialysis access surgeon as the change may indicate that the access has narrowed.