Grafts and Seroma: 10 Common Questions

A doctor may suggest a graft if your veins are too small or not elastic enough, an earlier fistula has failed, you need to start dialysis sooner, or you are older or have other chronic conditions. The operation is done under local anesthesia: the graft is placed under the skin and connected to an artery at one end and a vein at the other, and most people do not need to stay in hospital. Whether it suits you can only be judged after a physical examination and vascular ultrasound.

An early-cannulation graft can usually be needled for dialysis within 24 to 72 hours after surgery, so a catheter may not be needed first. A conventional graft takes three to four weeks. Early-cannulation grafts have a three-layer structure so the needle holes seal more readily and ooze less. National health insurance currently covers one of them (Flixene); self-paid products are also available.

There is no fixed lifespan, and it differs from person to person. Like a fistula, a graft develops narrowing or clotting after a period of use, and when found early it can often be treated with balloon angioplasty. In data compiled by the UK Kidney Association, a graft’s primary patency at two years was about 40%, and secondary patency after interventions about 60%. These are group figures and do not describe any individual patient.

A seroma is a collection of sterile, clear fluid around a graft, enclosed in a thin membrane. It is uncommon and usually causes no symptoms; it may appear within a month of surgery or only after several years. But swelling beside a graft is not always a seroma. It can also be an infection or an aneurysm, and only a doctor’s examination can tell them apart.

Whether a seroma without symptoms needs treatment is for the doctor to decide. If fluid keeps leaking from the graft, fibrin glue or thrombin can be injected, or the graft can be wrapped to seal it. Surgical drainage with removal of the seroma, or replacing the graft, is the more definitive approach.

Redness, swelling, warmth and pain are the usual signs, sometimes with discharge, and there may be fever. Grafts are infected more often than fistulas. A severe infection can lead to sepsis, and a thinned vessel wall may rupture and bleed heavily, so please seek care promptly if you notice these signs.

Not always. Early on, antibiotics are used actively and the infected site is not needled again. Only when medicine cannot control the infection is removal of the infected vessel considered, with a temporary dialysis catheter in the meantime, and the access is rebuilt once the infection is fully controlled.

HeRO is a hybrid access device. One end is a graft connected to an artery, and the other is a venous outflow tube that runs straight into the right atrium, bypassing a blocked central vein. It is used for people with severe central vein stenosis or occlusion, those whose fistulas or grafts have failed and who depend on a catheter for the long term, and those who have run out of usable vessels in the arm. In a 2025 JVS study of 232 patients, primary patency at five years was 4.3% and secondary patency after interventions was 28.0%. Common complications were hematoma (9.9%), steal syndrome (9.9%) and wound infection (7.8%).

The article on this site describes one case from abroad: a 44-year-old man whose fistula had formed a thrombosed aneurysm. The surgeons stitched a bovine pericardial patch into a tube to rebuild it, and at one month there was no sign of rejection, infection or re-narrowing. This is a single case report. In Taiwan, national health insurance coverage for pericardial patches is mainly for congenital heart surgery and reconstruction of the aorta or pulmonary artery, so reconstruction of a dialysis access usually does not qualify.

If the thrill in your graft weakens or suddenly disappears, it may have clotted; please contact the dialysis unit or a vascular surgeon the same day. The clot is usually removed with a minimally invasive procedure, and the narrowing that caused it is then treated with a balloon. The sooner it is treated, the better the chance of keeping the existing graft.