Dialysis Graft

A dialysis graft is a minor surgical procedure. It makes it easier for healthcare providers to access your bloodstream for hemodialysis. Hemodialysis is a treatment for people whose kidneys aren’t working as they should. It uses a machine to remove blood from your body, filter out waste products and return clean blood to you.

During a dialysis graft procedure, providers use a soft, hollow tube (graft) to connect an artery to a vein. Your arteries move a lot of blood through your body at a higher pressure. Your veins have lower flow and pressure. The graft creates the best blood flow and pressure rate for hemodialysis. During hemodialysis, providers use needles to access the graft instead of a blood vessel.

Another name for a dialysis graft is an arteriovenous (AV) graft.

What happens during a dialysis graft?

Dialysis graft placement is a minor procedure. You won’t be asleep — healthcare providers often use local anesthesia to numb the area — and you can usually go home the same day. Providers often place the graft in your nondominant arm (the arm you don’t use for tasks like writing or eating). But sometimes, they may place it in your leg. Before the procedure, your provider may instruct you to:

• Arrange for a family member or friend to take you home
• Take off any jewelry, including bracelets, watches and fitness trackers
• Wear comfortable, loose-fitting clothing so you can easily change into a hospital gown
• Stop taking medications that increase your bleeding risk, like nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol®), blood thinners and even some herbal supplements

Don’t stop taking medications unless your provider tells you to.

Your provider will:

1. Make two small cuts (incisions) to access a vein and artery
2. Use sutures (stitches) to connect the graft to your artery
3. Stitch the other end of the graft to your vein
4. Use stitches to close your incisions and cover the sites with bandages

Your provider may use one of two types of grafts: straight or looped. A looped graft looks like a hairpin. It has a ring that helps prevent the graft from twisting and pinching shut (kinking). Straight grafts may be more likely to kink than looped grafts.

What type of provider performs a dialysis graft?

Usually, an interventional radiologist or vascular surgeon creates a dialysis graft. Interventional radiologists use imaging tests and small medical devices to diagnose and treat conditions. Vascular surgeons diagnose and treat conditions that affect your blood vessels.

How long does it take?

Dialysis graft surgery usually takes a few hours to complete. In most cases, you can go home after the procedure. But you should have a family member or friend drive you home.

What are the potential benefits and risks of a dialysis graft?

Dialysis graft benefits include:

• It’s a good alternative to a dialysis fistula if your veins are small or weak.
• Providers can usually use it for dialysis a few weeks after the procedure.
• Recovery is often quick and easy.

Dialysis graft risks include:

• Blood clots that slow down or even stop blood flow
• Bulge in your artery wall (aneurysm)
• Greater chance of infections at the access site
• Your artery “steals” blood that’s supposed to go to the arm or leg in which the graft was placed (steal syndrome)

Does it hurt?

Yes, you’ll probably have some pain, bruising and swelling in your arm for several days afterward. You can help reduce pain with NSAIDs or acetaminophen. Not everyone can take NSAIDs or acetaminophen, so it’s a good idea to check with a provider first.

Keeping your elbow straight and propping it up on some pillows can help reduce swelling.

How long will it take for me to feel better?

In general, healthcare providers can use a dialysis graft for hemodialysis about three weeks after the procedure. But your body is unique. You may heal more quickly or more slowly. Your provider will give you a better idea of what to expect.

Once you heal, you should feel your graft slightly vibrate, buzz or pulse when you touch the area. It may feel like a purring cat. This is good — it means blood is flowing through your graft.

What is the life expectancy of a dialysis graft?

Dialysis grafts aren’t permanent. On average, they last about two to three years. Once it stops working, you may need another procedure to remove a clot. They may also replace the graft or put one somewhere else in your body.

Is there anything I can do to make a dialysis graft easier on me?

The following tips can help as you recover:

• Avoid driving. If you must go somewhere, it’s a good idea to have someone else drive you.
• Avoid stress or pressure. Examples include sleeping on your affected arm, wearing tight clothing or jewelry, or lifting anything heavier than 10 pounds (4.5 kilograms — about a gallon of water).
• Keep it dry. Wash the area gently with soap and water and gently pat it dry. Avoid swimming. You can bathe. But cover your arm in plastic while in the shower or bath.
• Squeeze a stress ball. This can help alleviate numbness or coldness you may feel in your hand after the procedure. It also helps strengthen your access. A strong access makes hemodialysis faster and easier to complete. It also helps prevent blood clots.
• Wear a pad or arm guard. This can help protect you from accidental bumps in the area.

When should I call my healthcare provider?

Call a healthcare provider if you don’t feel a vibration in your dialysis graft. It’s also a good idea to call if you think you damaged it. Symptoms may include:

• Bleeding more than usual at the graft site
• Bruising
• Bulging around your graft
• Discoloration or warmth
• Pain
• Swelling

Is a dialysis graft better than a fistula?

No. A dialysis fistula is the safest and most effective way to access your blood for hemodialysis. It usually lasts longer than a dialysis graft. You also have a lower risk of infection with a fistula.

What is the difference between a fistula and a graft?

A dialysis fistula directly connects your artery and vein. A graft uses a tube to connect your artery and vein.