AV (arteriovenous) fistulas and AV grafts are surgical procedures that are performed primarily by vascular surgeons but also some general surgeons. In creating an AV fistula, a vein in the arm is directly connected to an artery. The high-pressure high flow of arterial blood shunted into the vein causes the vein to dilate and thicken. This then allows the dialysis nurse to place needles in the vein to both withdraw and reinfuse blood for dialysis. An AV graft creates this connection from the artery to the vein using a plastic tube which is placed beneath the skin. The drawback for both is that there is some minor pain involved with the placement of needles although this tends to lessen over time. AV fistulas require 8 to 12 weeks to mature before use; AV grafts 2 to 3 weeks. Fistulas are more desirable in that they are less prone to clotting, have a lower infection rate, and when not being dialyzed there is nothing external to interfere with the activities of daily living. AV grafts have a slightly higher infection rate and clotting rate than AV fistulas but there is nothing external when not being dialyzed.
The current recommendation is that the majority of patients receiving hemodialysis should be dialyzed by fistulas with less by AV grafts and least by catheters as catheters provide the most complications. Your doctor may refer you prior to needing hemodialysis when your kidneys have a borderline function to avoid ever having the need for a catheter.