AV Fistulas: Always the First Choice
Arteriovenous fistulas (AVFs) are considered the gold standard for hemodialysis access. They provide the best long-term results for patient survival and quality of life when compared to grafts (AVGs) or central venous catheters (CVCs). The main reasons for choosing AVFs are their longevity, safety, and performance.
- Superior Durability (Longevity)
AVFs are created by joining a patient’s own vein to an artery. Since they use the body’s own tissue, they tend to stay open and functioning longer than other options.
- Self-Healing:
Because an AV fistula is made from living tissue, it can repair itself after repeated needle sticks during dialysis, unlike synthetic grafts. - Lifespan:
A good AVF can last for many years, sometimes even decades. In contrast, grafts usually last only 1 to 3 years, and catheters are meant for short-term use, from weeks to a few months.
- Lowest Infection Risk
This is the most important safety benefit.
- No Foreign Material:
Grafts involve a plastic tube (PTFE), and catheters involve a silicone tube exiting the skin. Bacteria can easily colonize these foreign surfaces (biofilm formation). - Closed System:
Because an AVF is completely under the skin, there is no permanent opening for bacteria to enter. The infection rate for AVFs is much lower than for catheters, with about a seven-times lower risk of bloodstream infection.
- Lower Thrombosis (Clotting) Rates
- Natural Endothelium:
The inside of an AVF is lined with the patient’s own cells, which help prevent clotting. - Fewer Blockages:
Synthetic grafts and catheters are more likely to trigger clot formation, leading to frequent blockages. These often require repeated procedures to keep them open.
- Better Dialysis Adequacy
- High Flow:
A mature AVF can handle the high blood flow rates needed for effective dialysis, which helps clean the blood well during each session.
Lower Recirculation:
AVFs typically mix less cleaned and unclean blood than catheters, making dialysis more efficient.
