It is important to have control, where possible, over the quality of your healthcare. One way to do this is by considering an arterio-venous fistula (AVF). Fistulas have been termed the “gold standard” of hemodialysis access. They last longer, need less rework and are associated with lower rates of infections, hospitalizations and death than other types of access.

Fistula - An arterio-venous fistula is created by sewing together the person’s own native artery and vein.

Graft – A graft is usually a soft, synthetic tube that is connected at one end to an artery and at the other end to a vein, usually in your arm.

Catheter - A catheter is a “y-shaped” plastic tube. It is surgically placed into a vein in your neck, chest or occasionally, groin.

There are many factors that go into deciding which type of vascular access is best for you. The most important factor that is taken into consideration by the healthcare team is the wishes of a well-informed and knowledgeable patient who has all the facts. Educating yourself is the first step toward being in control of your dialysis and healthcare. Deciding to choose a fistula is a good choice.

The Advantages of Fistulas
• Last a long time – years, not weeks or months as other accesses
• Few infections
• Fewer hospitalizations
• Better blood flow for better dialysis
• Least chance of clotting
• Preferred type of access

Where to Start
• Talk to your nephrologist
• Get a referral to an experienced vascular (blood vessel) surgeon
• Ask your surgeon if ‘vein mapping’ (ultrasonic test and physical assessment of
arteries and veins) would be helpful
• Ask your surgeon about doing a ‘venogram’ (x-ray of the blood vessels)

Help For You
The social worker at your dialysis facility can support you as you talk with your nephrologist and surgeon. Ask questions and more questions. The choices you make should be well informed, and consulting with your nephrologist and treatment team is an important step.

For more information about your access options, order AAKP’s Understanding Your Hemodialysis Access Options. This 16-page brochure outlines various access devices available for hemodialysis patients. The brochure offers a brief description of arteriovenous fistulas, grafts, catheters and subcutaneous access devices as well as the benefits and drawbacks of each. The brochure also includes a brief section on how to properly care for each kind of access device.  Call 800-749-AAKP to request a copy be mailed to you. This brochure is available in English and Spanish.

You are the one who will live with the choice you make. Choice is Control!

This article is a reprinted with permission from The Florida ESRD Network September 2007 Patient Newsletter.

This article originally appeared in the July 2008 issue of aakpRENALIFE.

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