When kidney function drops below 10 to 15 percent of normal, which is known as renal or kidney failure, dialysis treatments or a kidney transplant are needed to sustain life.

In hemodialysis, the patient’s blood is passed through an artificial kidney (dialyzer) where it is cleaned of toxins and extra fluids before being returned to the body. A vascular access is needed for the process, and having the best type of access is important in order to achieve optimal results. There are three types of vascular access: catheter, graft and fistula.

Catheter. A catheter is a small, plastic tube that is inserted into a large vein in the neck or chest. Catheters are typically used on a short-term basis when there is a need for immediate dialysis. Long-term use of a catheter is not recommended because catheters tend to perform poorly and carry the highest risk of infection.

Arteriovenous (AV) Graft. A graft is a small, soft tube placed under the skin that connects a vein to an artery for hemodialysis. Grafts are easy to use, are usually ready for use within about three weeks of placement, and can be placed in almost anybody. Drawbacks to grafts are they typically last no more than three years, clot more often than fistulas, require more upkeep and are more likely to get infected.

Arteriovenous Fistula (AVF). A fistula, also known as an AVF, is a surgical connection of an artery to a vein, usually in the arm or forearm, to provide an entry and exit point for dialysis. Fistulas are recognized as the gold standard of vascular access because they last longer (sometimes for decades), need less rework or repairs, and are associated with lower rates of infection, hospitalization and death. Drawbacks to fistulas are that there is typically a waiting period of up to three to four months before they are ready for use, and they’re not an option for all patients.

As testament to the significant benefits AVFs offer to patients, the Centers for Medicare and Medicaid and members of the renal community have come together to start Fistula First, a nationwide industry initiative to expand the number of patients with fistulas. The campaign estimates that in America as many as 5,000 deaths could be prevented each year if more renal patients used AVFs. Additionally, AVFs cost less to place and maintain than other forms of access and are associated with fewer complications requiring hospitalization.

At the Premier Vascular Access & Imaging Center, we’re going above and beyond the Fistula First AVF placement goal of 66 percent, and we’re seeing the benefit of creating a healthier patient population.

If you expect to start dialysis within the next year and have not yet had a vascular access placed, I strongly recommend that you ask your doctor to refer you to a vascular surgeon who has experience placing fistulas.