An arteriovenous (AV) fistula and an AV graft are the two types of long-lasting vascular accesses.

• AV fistula. A vascular surgeon creates an AV fistula by connecting an artery directly to a vein. An artery is a blood vessel that carries blood from the heart to the rest of the body. A vein is a blood vessel that carries blood from the body back to the heart. The vascular surgeon usually places an AV fistula in a person’s forearm or upper arm. An AV fistula causes the vein to expand and thicken, providing easy, reliable access to blood vessels. Doctors often recommend the AV fistula over the other types of access because it

• • 1. provides adequate blood flow for dialysis
    2. lasts a long time
    3. has a lower complication rate than other types of access
  You may need to stay overnight in the hospital, or you may be able to go home after the procedure. You will get local anesthesia to numb the area where the vascular surgeon creates the AV fistula. Depending on your situation, you may get general anesthesia, in which you are not awake during your procedure.

• AV graft. If your vascular surgeon cannot create an AV fistula because of problems with your veins, you may need an AV graft instead. An AV graft is a connection from an artery to a vein using a synthetic, or man-made, tube that is usually bent or looped. You may need to stay overnight in the hospital, or you may be able to go home after the procedure. You will get local anesthesia to numb the area where the vascular surgeon creates the AV fistula. Depending on your situation, you may get general anesthesia during your procedure. You can use an AV graft soon after it is inserted. An AV graft is more likely to have problems with infection and blood clots. The repeated formation of blood clots can block the flow of blood through the AV graft and make it hard or impossible to do the hemodialysis treatment.