• Central Lines (or Central Venous Catheters)
• Arteriovenous Fistula (AVF)
• Prosthetic Grafts
• How long will my access last?

Lake Washington Vascular surgeons are committed to offering excellent care to patients with kidney failure. The relationship between a dialysis patient and the vascular surgeon is important and long lasting. The types of dialysis access are Central Lines (or Central Venous Catheters), Arteriovenous Fistula (AVF) and Prosthetic Grafts.

Central Lines (or Central Venous Catheters)
These are placed when dialysis needs to be initiated urgently or access fails. Central lines can be used right away but are not considered permanent. They can become clogged and stop working and sometimes cause infection. They can also cause central vein thrombosis (clotting).

Central venous catheters are positioned into the deep veins of the upper chest for the purpose of pulling and returning blood to and from the dialysis machine. Central venous catheters are usually inserted through a neck vein, and may be tunneled so as to exit the skin below the collarbone.

The veins through which the central venous catheter passes are at risk for clotting. For these reasons, unless dialysis is expected to be temporary, permanent dialysis access should replace central venous catheters as soon as possible.

Tunneled central venous catheter		Arteriovenous fistula		Prosthetic graft

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Arteriovenous Fistula (AVF)
The optimum access is a primary arterial venous fistula (AVF) using the patient's own tissue if they have adequate vein. Vascular surgeons always prefer to start as far peripherally as possible and prefer to use the non-dominant arm if the vein there is suitable. Vascular surgeons follow these guidelines in creating AV fistulas:

• Always use natural vein before going to synthetic grafts.
• Try to use the patient's non-dominant arm if the vein is suitable, so as to free up the dominant arm during the time on the dialysis machine.
• Start as peripherally as the vein allows, to increase options for the future if needed.
• Upper extremity fistulas are always preferable to lower extremity fistulas.

The risks of creating an AVF or inserting a graft include bleeding, infection, clotting off of the fistula or graft with need for revision or re-operation, steal syndrome where too much blood goes out of the arm up the fistula and not enough is left in the hand. In some circumstances this could require tying off the fistula. After creation, fistulas need to "mature" (or grow in size) for a minimum of six weeks before use.

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Prosthetic Grafts
When veins are too small for an Arteriovenous Fistula, a prosthetic graft is used. This can be used for dialysis within two weeks of surgery. Grafts don't last as long as fistulas and can become infected. If an artificial graft is placed and it becomes infected, it usually needs to be removed to help eradicate the infection.

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How long will my access last?
There is no fistula or graft that works forever. We pledge to continue to work with our patients as needed to maintain access so they can continue to dialyze, but they have to understand that this might require revisions. It is in their interest for us to start as far peripherally as we can and move up the arm if needed rather than do the easiest procedure first, which might limit long-term options.

For more information about dialysis access, go to www.Vascularweb.org for patients with kidney failure.

Additional information can also be found at the following links:
National Kidney Foundation,

American Association of Kidney Patients

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