Dialysis access is a lifeline for patients with kidney failure. An AV fistula, created by a vascular surgeon, is the most reliable and natural method for long-term hemodialysis. When not feasible, AV grafts or permacaths may be used. Our goal is to ensure safe and durable dialysis access for every patient.
For patients with kidney failure, dialysis becomes a routine part of life — a life-sustaining process that removes toxins and excess fluid from the body when the kidneys are no longer able to. To perform dialysis effectively, a reliable and safe access to the bloodstream is essential.
This is where dialysis access surgery plays a critical role. As vascular surgeons, we specialize in creating and maintaining these access points. The most preferred and natural method is the arteriovenous (AV) fistula, but alternatives like AV grafts and permacaths (tunneled catheters) are also used when required.
An AV fistula is a direct surgical connection between an artery and a vein, typically in the arm. It is the gold standard access for hemodialysis because it is made using your body’s own blood vessels, making it durable and less prone to complications.
The procedure is simple and done under local anesthesia. Once created, the fistula takes about 4–8 weeks to mature, during which the vein becomes thicker and stronger to handle repeated needle insertions during dialysis.
AV fistulas are the first choice for long-term dialysis access, recommended by nephrologists and surgeons worldwide.
| Benefit | Description |
|---|---|
| Long-lasting | Can function for years if well maintained. |
| No artificial material | Made from your body’s natural tissues. |
| Lower infection risk | Much safer than artificial access. |
| Less risk of clotting | Blood flow remains steady. |
| Faster and more efficient dialysis | Better clearance during sessions. |
| Fewer hospital visits | Less prone to emergencies compared to other options. |
The process begins with a detailed evaluation of your blood vessels. This includes:
This step is called “vessel mapping” or “vessel planning” and helps us decide the best site for your AV fistula — usually in the forearm or upper arm.
Once the right spot is chosen:
After the surgery, the fistula needs 4 to 8 weeks to mature. During this time:
Once matured, two needles are inserted into the fistula during dialysis: one to draw blood out, and another to return it after filtering.
In some patients, AV fistula creation may not be possible due to:
In such cases, alternative access options are explored.
If a patient’s veins are not suitable for an AV fistula, the next best option is an AV graft.
An AV graft is a synthetic tube (made of a special medical material called PTFE) that connects an artery to a vein, usually in the upper arm. The graft acts as a bridge for the blood flow and is used like a fistula for dialysis.
However, with proper care and regular follow-ups, AV grafts can function effectively for long durations.
If no fistula or graft can be placed in the arms, or if immediate dialysis is needed, a permacath is used.
A Permacath is a soft plastic tube inserted into a large vein in the chest or thigh, with the tip sitting close to the heart. It is tunneled under the skin for stability and lower infection risk compared to temporary catheters.
A Permacath is considered a temporary or intermediate solution and is best avoided as a long-term option.
Every patient is different. The choice of access depends on:
| Feature | AV Fistula | AV Graft | Permacath |
|---|---|---|---|
| Material | Natural (your veins) | Synthetic tube | Plastic catheter |
| Infection Risk | Low | Moderate | High |
| Longevity | Longest | Moderate | Short-term |
| Time to Use | 4–8 weeks | 2–3 weeks | Immediate |
| Insertion Site | Forearm/arm | Arm | Chest/thigh |
| Best For | Long-term dialysis | Poor veins | Urgent use or no access |
Whatever the type of access, proper care is crucial to avoid complications.
Regular ultrasound monitoring may be done to assess function and prevent blockage.
As vascular specialists, we focus on:
Our goal is to maximize the lifespan of your access, reduce complications, and ensure smooth, effective dialysis sessions.
It is made from your own artery and vein, so it lasts longer and carries a lower risk of infection and clotting than an AV graft or a permacath.
Usually after 4 to 8 weeks, once the vein has grown thicker and stronger. An AV graft can usually be used within 2 to 3 weeks.
No. A fistula is usually made under local anaesthesia through a small cut in the arm.
Keep the area clean and dry and check it daily for swelling, redness or bleeding. Do not sleep on that arm or wear tight clothing over it, and do not allow blood pressure readings or IV lines in that arm.
For long-term dialysis, an AV fistula is better. It is made from your own artery and vein, lasts longer and has a much lower risk of infection and blockage. A permacath is useful when dialysis is needed straight away or when a fistula cannot be made, but it is best used as a bridge until a fistula or graft is ready.
A permacath can work for several months, sometimes longer. But the longer it stays in, the higher the risk of infection, blockage and narrowing of the vein it sits in. That is why we plan a fistula or graft early, so the catheter can come out as soon as possible.
It is placed under local anaesthesia, usually through the large vein in the neck (the internal jugular vein), with ultrasound guiding the needle. The catheter is tunnelled under the skin so it comes out on the upper chest, and a small cuff under the skin holds it in place and helps keep out infection. An X-ray confirms the tip sits just above the heart. The procedure usually takes under an hour, and the catheter can be used for dialysis the same day.
No. A thrill is the buzzing vibration you can feel over a working fistula or graft, caused by fast blood flow from the artery into the vein. A permacath is a tube inside a vein, so there is no thrill. If a fistula or graft loses its thrill, it may have clotted and needs urgent review.
AVG stands for arteriovenous graft: a soft synthetic tube placed under the skin of the arm to join an artery to a vein. The dialysis needles go into the tube. It is used when the veins are too small or damaged for a fistula, and can usually be used 2 to 3 weeks after surgery.
A fistula is better when your veins allow it. It lasts longer and has fewer infections and blockages. A graft is the next choice when the veins are not suitable, and it can be used sooner.
No. The tube in the chest is a permacath, a tunnelled catheter in a large vein. A fistula is a joint between your own artery and vein, usually in the arm. People sometimes call the chest catheter a “chest fistula”, but a fistula is the better long-term option.
Yes. Dialysis can start through a permacath while a fistula or graft is being made, and patients who cannot have a fistula can use a graft. Peritoneal dialysis, done through a tube in the abdomen, needs no fistula at all.
A well-planned access allows for efficient dialysis, fewer hospital admissions, and better quality of life. If you or your loved one is preparing for dialysis, consult a vascular surgeon early. We’re here to help you plan your journey with confidence, safety, and the best long-term outcomes.
