Creating an arteriovenous graft (AVG) for dialysis is an alternative way of building dialysis access when a patient’s own vessels are not suitable for a native arteriovenous fistula (AVF). A synthetic graft is used to connect an artery and a vein, providing a stable blood-flow route for dialysis. Whether an AVG is suitable can only be determined after a physician has assessed the vessels in person.
What is an AVG, and how does it differ from a native fistula (AVF)?
AVG (arteriovenous graft) uses a synthetic graft to connect an artery and a vein inside the body, creating an access that can be needled for dialysis. An AVF (arteriovenous fistula) joins the patient’s own artery and vein directly, so that the vein gradually enlarges and thickens and, once matured, serves as the dialysis access. Both aim to provide enough blood flow for dialysis; which one is chosen depends on the patient’s own vessels.
| Item | AVG (synthetic graft) | AVF (native fistula) |
|---|---|---|
| Material | Grafts | The patient’s own vessels |
| Suitable for | Patients with poor vessels who cannot have a native fistula | Patients with good vessels: a vein that is large and healthy enough |
| Maturation time | Relatively short | Weeks to months for the vessel to mature |
| Common considerations | Infection risk and access lifespan vary from case to case | Usually regarded as one of the preferred options for long-term use |
In practice, the physician first assesses the patient’s vessels and gives priority to whether an AVF can be created. Only when the vessels are truly unsuitable (for example, they are too small, or there is another vascular disease) is an AVG recommended. To learn more about how fistula maturation is assessed, see: How to Predict the Success Rate of an Arteriovenous Fistula (AVF).
When might a physician recommend an AVG?
Situations in which an AVG is commonly considered include:
- Veins that are poor, too small or not elastic enough to create a native fistula
- A previous attempt to create an AVF was unsuccessful, or fistulas have failed repeatedly
- A need to start using dialysis access quickly, without waiting for an AVF to mature
- Older age or other chronic conditions that limit the condition of the vessels
Whether an AVG is suitable can only be decided by the physician after a physical examination and vascular ultrasound. Every patient’s vessels are different, so individual consultation is recommended.
How is the AVG procedure performed? Is it painful?
AVG creation can be performed under local anesthesia. The physician places the synthetic graft under the skin and connects its two ends to an artery and a vein, creating an access that can be needled. Anesthetic is injected at the surgical site. Because the procedure is minimally invasive, the incision is not large; pain varies from person to person, and more sensitive patients may feel somewhat more discomfort.
Most patients recover quickly after surgery, although the actual recovery time depends on the individual. Whether a hospital stay is needed depends on the case; unless there are special considerations, the physician will explain this clearly before the procedure.
Is it covered by national health insurance? When can it be used?
Most of the cost of AVG creation is covered by national health insurance (NHI); the actual coverage depends on the individual case, so please confirm with the care team. Compared with an AVF, which needs weeks to months to mature, an AVG can usually be used sooner once the wound has healed, which suits patients who need access quickly. The actual time to first use is determined by the physician’s assessment. See also: Reflections on Early-Cannulation Grafts
Key points for everyday care after AVG creation
Daily care of a graft access is similar to that of a native fistula, and both the patient and family should stay alert:
- Feel the access every day for the thrill (vibration) to confirm that blood is flowing normally
- Watch for signs of infection around the access, such as redness, swelling, warmth or discharge, and return to the clinic early
- Avoid measuring blood pressure, drawing blood or lifting heavy objects with the access arm, to reduce pressure on the access
- Schedule regular follow-up and vessel assessment as your physician advises, so that problems such as stenosis are found early
If the thrill becomes weaker, the hand becomes swollen or cold, or blood cannot be drawn smoothly during dialysis, return early for assessment. For more complete guidance on access care, see this other article: Narrowed Dialysis Access: What to Do? Essential Access Care and Treatment.
Frequently Asked Questions
Q1: Which is better, an AVG or a native AVF?
A: It depends mainly on the patient’s own vessels. When the vessels are good, creating an AVF is usually assessed first; when the vessels are poor and a native fistula cannot be created, an AVG is an important alternative. The actual choice is made after the physician’s assessment.
Q2: Can an AVG still narrow or become blocked?
A: Like a native fistula, a graft access can develop stenosis or blockage over time. This is why regular follow-up and daily palpation matter; when found early, it can usually be treated, for example with balloon angioplasty.
Q3: Does AVG surgery always require a hospital stay?
A: Most patients do not need to stay in hospital. In special cases, the care team will explain this clearly before the procedure.
Q4: How soon can I start dialysis with an AVG?
A: Compared with an AVF, which needs weeks to months to mature, an AVG can usually be used sooner once the wound has healed. The actual timing still depends on the physician’s assessment of your individual situation.
Even with poor vessels, a suitable dialysis access plan can be found
Whether it is an AVG or a native AVF, the choice of access can only be confirmed after a physician has assessed the vessels in person. If you or a family member are struggling with poor vessels and cannot find a suitable dialysis access, you are welcome to consult at the clinic so that the care team can help assess a suitable plan.
