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Vascular Access & its Types

What are the different types of Vascular Accesses?

There are three types of vascular access:

  • Arteriovenous (AV) fistula
  • Arteriovenous (AV) graft
  • Central venous catheter (CVC)

These accesses can also be categorized as “Temporary” & “Permanent” Vascular Accesses.

Temporary Access Types

  • Internal Jugular Access (a type of CVC)
  • Femoral Access (a type of CVC)
  • Permanent Cathter (a type of CVC)

Permanent Access Types

  • Arteriovenous (AV) fistula
  • Arteriovenous (AV) graft

How are Vascular Accesses created? And where on the human body can they be created?

Each access is created surgically. There are a limited number of places on the body where an access can be placed—the arms, legs, neck or chest.

Which Vascular Accesses are considered to be permanent?

The fistula and graft are considered to be permanent accesses because they are placed under the skin with a plan to use them for many years.

When are Permanent Vascular Accesses created?

When patients find out they are in the advanced stages of chronic kidney disease and will be starting dialysis in the future, their nephrologist may advise them to get a fistula or graft. Having the access in place well before beginning dialysis will give this lifeline time to “mature,” so it can be ready to use.

What is a temporary vascular access and in what conditions are they created?

A catheter is used as a temporary vascular access.
When patients suddenly discover they have kidney failure, a catheter may be placed to allow for immediate dialysis treatment. The catheter will be used until a fistula or graft has time to mature. A catheter can also be used on a permanent basis, if the patient is unable to have a fistula or graft—but a catheter is always a last resort. And a new catheterization procedure will have to be done periodically to change the catheter used.

What is an AV Fistula access?

An AV fistula is created by directly connecting a person’s artery and vein—usually in the arm. This is a simple procedure and may be performed as an outpatient operation using a local anaesthetic. As blood flows to the vein from the newly connected artery, the vein grows bigger and stronger. The patient is taught to do exercises—such as squeezing a rubber ball—to help the fistula strengthen and mature to get it ready for use. This takes anywhere from six weeks to four months or more. Once the fistula has matured, it can provide good blood flow for many years of haemodialysis.
Kidney and haemodialysis experts, including consider the fistula the “gold standard” access choice. Research studies have proven patients with a fistula have the fewest complications, such as infection or clotting, compared to all other access choices.

Why the AV Fistula is considered the “gold standard” access?

The fistula is considered the “gold standard” access because it:

  • It a lower risk of infections than other access types
  • It has a lower risk of forming clots than other access types
  • It allows for greater blood flow
  • It lasts longer than the other access types
  • It can last many years, even decades, when well-cared for

People may have the following issues with fistulas:

  • The appearance of bulging veins at the access site
  • Taking several months for a new one to mature
  • A fistula not maturing at all in some cases

Can an AV Fistula be created for all dialysis patients?

No. Some people may not be able to have a fistula created due to weak arteries, veins or other medical conditions. It is best to discuss your access options with your nephrologist, but ask for a fistula first.

What is an AV Graft access?

The AV graft is similar to a fistula, in that it is also an under-the-skin connection of an artery and vein, except that with a graft, a man-made tubing connects the artery and vein. The soft, plastic-like tube is about one-half inch in diameter and is made from a type of Teflon or Gore-Tex material. Grafts are usually placed in the arm, but can also be placed in the thigh.

Pros & Cons of using an AV Graft over a AV Fistula access:

Pros-
Grafts do not require as much time to mature as fistulas, because a graft does not need time to enlarge before use. In most cases a graft can be used about two to six weeks after placement.
Cons-
Because grafts are created from materials outside of the body, they tend to have more problems than fistulas due to clotting and infections. Grafts may not last as long as a fistula and could need to be repaired or replaced each year.

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