AV Fistula & Graft Creation

What is dialysis access creation?

Haemodialysis needs a blood vessel that can deliver high flows, session after session, for years. An arteriovenous fistula (AVF) creates one by joining a vein directly to an artery — usually at the wrist or elbow — so the vein enlarges and thickens over the following weeks into a robust, needleable vessel. Where the veins are too small or scarred, an arteriovenous graft (AVG) places a soft synthetic tube between artery and vein to serve the same purpose. Both are covered in more detail on the dialysis access page.

Who it may suit

Anyone approaching haemodialysis, or already dialysing through a neck catheter, should have definitive access planned. Catheters carry infection and central vein injury risks that rise the longer they stay; creating a fistula early — ideally months before dialysis starts — avoids depending on them. A fistula is generally preferred where the vessels allow, because it uses your own tissue and tends to last longer with fewer infections; a graft matures faster and is the practical choice when veins are inadequate.

What the procedure involves

• Ultrasound vein mapping first — the veins and arteries of both arms are measured, and the access is planned as far down the arm as the vessels allow, preserving future options
• Performed under local or regional anaesthesia, usually as a day procedure
• A fistula typically needs around six to eight weeks to mature before it can be needled; a graft is usually usable sooner

What to expect afterwards

A soft buzz (thrill) over the access is normal — it means flow. The arm can be used normally within days, avoiding heavy compression over the site. Maturation is checked with ultrasound, and not every fistula matures on its own — a proportion need a small assisting procedure, which is part of normal access care rather than a failure. Swelling of the hand, wound issues and early blockage are uncommon but recognised.

Is it right for me?

Timing and side matter as much as technique. At consultation the vessels are mapped, and I go through the options with you — and with your renal physician — so the access is ready before the catheter becomes the plan.