Haemodialysis Arteriovenous Fistula/Graft Dysfunction

Haemodialysis (HD) is a procedure that filters waste products and excess fluid from your blood when your kidneys are no longer able to do this sufficiently. A fistula or graft is a surgically created access point that allows for efficient blood flow during hemodialysis. Arteriovenous fistula (AVF) dysfunction refers to impairment of a surgically created connection between an artery and a vein in your arm for hemodialysis. An arteriovenous graft (AVG) dysfunction refers to malfunction of a synthetic tube used to connect an artery and vein for hemodialysis access. Both fistula and graft dysfunction can significantly impact the effectiveness of hemodialysis treatment.

There are three main types of vascular access for hemodialysis:

Arteriovenous fistula (AVF):This is the preferred type of access because it lasts longest and has fewer problems. An AVF is created by joining an artery and a vein in your arm or leg. Over time, the vein widens and toughens, making it easier to insert needles for hemodialysis.

Arteriovenous graft (AVG):An AVG is used if your veins are not suitable for creating an AVF. An AVG is made of a synthetic tube that is sewn to an artery and a vein in your arm or leg.

Catheter: A catheter is a thin, flexible tube that is placed in a large vein in your chest or neck. A catheter is usually used for a short time, such as when you first start hemodialysis or while you are waiting for an AVF or AVG to mature.

Causes

Several factors can contribute to AVF or AVG dysfunction, including:

Stenosis: This is a narrowing of the fistula or graft due to scar tissue buildup.
Thrombosis: This is a blood clot that blocks the fistula or graft.
Infection: This can occur at the insertion site of the fistula or graft.
Aneurysm: This is a bulging weakness in the wall of the fistula or graft.
Low blood pressure: This can make it difficult for blood to flow through the fistula or graft.

Signs and Symptoms

Signs and symptoms of AVF or AVG dysfunction can include:

Swelling or redness around the fistula or graft
Pain or tenderness around the fistula or graft
Decreased or absent thrill (vibration) in the fistula or graft
Difficulty inserting needles into the fistula or graft
Poor blood flow during hemodialysis
Fever or chills (if infection is present)

Treatment

Treatment for AVF or AVG dysfunction will depend on the cause of the problem. Treatment options may include:

Angioplasty: This is a procedure that uses a balloon to open up a narrowed fistula or graft.
Stenting: This is a procedure that places a small tube (stent) in the fistula or graft to keep it open (Click here to read more on Angioplasty/ stenting)
Thrombolysis: This is a procedure that uses medication to dissolve a blood clot.
Surgery: Surgery may be needed to repair an aneurysm or to create a new fistula or graft.

Prevention

There are a number of things you can do to help prevent AVF or AVG dysfunction, including:

Following your doctor’s instructions for caring for your fistula or graft.
Keeping your fistula or graft clean and dry.
Avoiding lifting heavy objects with the arm that has the fistula or graft.
Checking your fistula or graft daily for signs of infection.
Monitoring your blood pressure and telling your doctor if it is low.

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Haemodialysis Arteriovenous Fistula/Graft Dysfunction