Understanding the Difference Between Fistula and Graft for Dialysis

When you find out you need dialysis, your doctor will talk to you about getting a fistula or graft. These are just medical names for the two ways to set up access in your arm so dialysis can work.

The difference between AV fistula and graft is pretty straightforward. One uses your own blood vessels, the other uses a tube. Each has pros and cons.

Why You Need Dialysis Access

Healthy kidneys clean your blood every day. When kidneys fail, dialysis takes over that job. Blood leaves your body through one tube, gets filtered by a machine and goes back in through another tube.

You need two needles for this, three times a week. Sometimes for many years. That’s why the access point in your arm matters so much.

What Is an AV Fistula?

A fistula connects an artery to a vein in your arm. Your surgeon does this using only your blood vessels.

Arteries push blood out from your heart with high pressure. Veins bring it back with low pressure. When you connect them, extra blood flows through the vein. This makes the vein grow bigger and tougher over a few months.

After it grows enough, nurses can stick needles in it for dialysis.

Benefits of AV Fistulas

Infection is rare. Since it’s made from your own tissue, infection happens less. Studies show 3% of fistulas get infected versus 14% of grafts.

They last. A good fistula can work for 10, 20, even 30 years.

Blood clots are less common. Your blood moves through naturally, so clots don’t form as much.

Blood flow is strong. This makes dialysis work better.

Problems With Fistulas

You have to wait. After surgery, it takes 8 to 12 weeks before you can use it. Some take even longer. You’ll need a catheter in your neck until it’s ready.

Not everyone’s veins work for a fistula. Small veins, damaged veins from old IVs, or certain health problems can rule it out. About 40 out of 100 fistulas never develop right, so you’d need to try again or switch to a graft.

What Is an AV Graft?

A graft does the same job but uses a soft plastic tube instead. The surgeon puts this tube under your skin and connects your artery to your vein with it.

Blood flows through the tube just like it would through a vein.

Benefits of AV Grafts

You can use it sooner. Most grafts work in 2 to 4 weeks. Studies show grafts take about 75 days to use versus 114 days for fistulas.

It works when fistulas won’t. If your veins are too small or weak, a graft is still an option.

Better success rate at first. About 19 out of 100 grafts fail right away, but 40 out of 100 fistulas do.

You might upgrade later. Sometimes dialysis makes your veins stronger. If that happens, you could get a fistula down the line.

Problems With Grafts

Plastic tubes cause more issues. Infections happen more often. Blood clots are more common and can completely block the graft.

Grafts wear out faster. Most last a few years, then you need a new one. They also need 2 to 3 times more doctor visits and procedures to keep working.

AV Fistula vs AV Graft: Quick Look

What to Compare	AV Fistula	AV Graft
Made from	Your blood vessels	Plastic tube
Wait time	8 to 12 weeks	2 to 4 weeks
Gets infected	3% chance	14% chance
Fails at start	40%	19%
Lasts how long	Decades	Few years
Needs fixes	Not often	More often
Best if	Your veins are good	Need quick access or weak veins

Which One Is Right?

It depends on you. Your surgeon looks at your veins, your health and how soon you need dialysis.

Most doctors try for a fistula first. They last longer and cause fewer headaches. But grafts make sense when you need dialysis fast, your veins won’t work for a fistula, you tried a fistula and it failed, or you have health problems that make fistulas risky.

Your doctor will check your arm veins and talk through the timeline with you.

How to Care for Your Access

Check it daily. Touch the spot with your fingers. You should feel a buzz. If the buzz stops or feels different, call your doctor.

Wash it. Use soap and water every day. Always wash before dialysis.

Don’t use that arm for blood pressure. Don’t let anyone draw blood from it either, unless it’s during dialysis. Don’t sleep on it. Don’t carry anything heavy with it.

Look for problems. Look for problems. Red skin, swelling, heat, or any sign of infection means call your doctor. Some dialysis patients also notice shiny skin on their lower legs, which can indicate circulation problems that need attention.

See your surgeon regularly. They’ll do ultrasounds and check-ups to catch problems early. Regular dialysis access maintenance keeps things working longer.

After Surgery

Both surgeries are same-day procedures. You get numbing shots and maybe something to calm your nerves. Then you go home.

Your arm will be sore for a few days. Take Tylenol or whatever your doctor says is okay. The cut is small, maybe 2 to 4 inches.

For a fistula, squeeze a soft ball or foam ball a bunch of times each day. This helps the vein get stronger.

For a graft, just wait. Your team will tell you when it’s healed enough to use.
Dialysis patients sometimes develop other circulation problems. Your kidneys and blood vessels are connected, so kidney disease can affect blood flow throughout your body.

Other Vascular Issues to Watch For

Dialysis can sometimes lead to other circulation issues since kidney disease affects blood flow throughout the body. Common problems include PAD (reduced blood flow to the legs), varicose veins from long dialysis sessions, foot numbness or even deep vein thrombosis. If you notice any of these signs, let your vascular surgeon know they can check for problems during your regular access visits.

Taking The Right Decision

When you understand the difference between an AV fistula and a graft, you know what you’re getting into. It comes down to your body and your situation.

Both can work for years if you take care of them. At Prime Vascular Care. We handle both AV fistula and graft procedures. The goal is to let you get your dialysis without problems.