Arteriovenous (AV) Graft SurgeryBy
Catherine Spader, RN
What is arteriovenous (AV) graft surgery?
Arteriovenous (AV) graft surgery creates a synthetic access point into the body’s circulatory system to perform dialysis. Dialysis removes wastes and extra fluid from your blood when the kidneys can no longer perform this function. This is known as kidney failure. AV graft surgery allows blood to flow from your body to the dialysis machine and back into your body after filtering.
AV graft surgery involves connecting a vein to an artery with an artificial tube or graft. The graft is usually made of synthetic material. Surgeons sometimes use a transplanted animal or human blood vessel.
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An arm is the usual location for an AV graft, but a thigh can also be used. The graft is tough and can tolerate the multiple needle punctures needed for dialysis better than a normal vein. After AV graft surgery, you will feel a “buzzing” sensation over the graft.
AV graft surgery carries some risks and potential complications. It is only one option for dialysis access. Other options include an AV fistula (directly sewing an artery and a vein together) and a venous catheter, which is for short-term dialysis. I
AV graft surgery is generally for people who need long-term dialysis and have small or unhealthy blood vessels. You may have other dialysis access options. Consider getting a second opinion about all your dialysis access choices before having AV graft surgery.
Why is arteriovenous (AV) graft surgery performed?
Your doctor may recommend arteriovenous (AV) graft surgery as part of a complete dialysis treatment plan for kidney failure. Kidney failure is a life-threatening condition in which there is a buildup of waste and fluid in the body due to poor kidney function. Dialysis uses a machine to filter wastes and extra fluid from the blood.
People with kidney failure may require dialysis permanently or for a short time. Kidney failure that occurs suddenly (acute kidney failure) can sometimes be reversed by rapidly treating the cause, such as a drug overdose, shock, or a kidney infection.
AV graft surgery is often used for people who have small or unhealthy blood vessels and need long-term dialysis for permanent kidney damage. People who have AV graft surgery may be waiting for a kidney transplant.
Your doctor may recommend AV graft surgery for kidney failure due to:
Autoimmune diseases including systemic lupus erythematosus that affects the kidneys
Certain inherited diseases including polycystic kidney disease, which causes large cysts in the kidneys that damage kidney tissue
Conditions that reduce blood flow to the kidneys including shock and renal artery stenosis (narrowing of the renal arteries)
Diseases that cause kidney inflammation including nephritis and glomerulonephritis
Infections including repeated bladder infection, pyelonephritis (kidney infection), or septicemia (blood infection)
Medication use or abuse including intravenous (IV) drug abuse, overdose of certain drugs, or long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
Poorly treated or untreated chronic diseases including diabetes and high blood pressure that cause kidney damage over time
Trauma including injuries to the kidneys or arteries that supply blood to the kidneys
Urinary tract obstructions including kidney stones, tumors, congenital deformities, and enlarged prostate glands
Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on AV graft surgery.
Who performs arteriovenous (AV) graft surgery?
A general surgeon or vascular surgeon performs arteriovenous (AV) graft surgery. A general surgeon specializes in the surgical treatment of a wide variety of diseases, disorders and conditions. A vascular surgeon specializes in surgery of the blood vessels.
How is arteriovenous (AV) graft surgery performed?
Your arteriovenous (AV) graft surgery will be performed in a hospital or outpatient surgery center. Surgeons usually create AV grafts in the arm, but sometimes they use the thigh.
Your surgical team will clean the surgical site and start anesthesia. Your surgeon will make an incision and connect an artery to a vein with a synthetic tube (graft) or a transplanted animal or human blood vessel. The graft allows access to your circulation for dialysis. Your surgeon will restore blood flow through the blood vessels when they are completely connected with the graft and close the incision with stitches.
Types of anesthesia that may be used
Surgeons often perform AV graft surgery using local anesthesia while the patient is sedated. Local anesthesia involves injecting an anesthetic in the skin and tissues around the surgery area to numb the area. You may have another form of anesthesia, depending on your case:
is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your AV graft surgery
The day of your AV graft surgery, you can generally expect:
To talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form. It is important to verify the correct surgical site with the operating staff.
To remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
To talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and all vital signs are stabile.
What are the risks and potential complications of arteriovenous (AV) graft surgery?
As with all surgeries, arteriovenous (AV) graft surgery involves risks and potential complications. An AV graft generally has more complications than an AV fistula, in which the artery and the vein are sewn directly together without a graft.
Complications of AV graft surgery may become serious and life threatening in some cases. Complications can occur during the surgery, throughout your recovery, or after the AV graft has been used for months or years of dialysis.
General risks of surgery
The general risks of surgery include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
- Bleeding, which can lead to shock
- Blood clot, particularly a deep vein thrombosis (a clot that may develop in the leg or pelvis). A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack or stroke.
- Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of AV graft surgery
Complications of AV graft surgery can be serious. You can reduce the risk of potential complications by following your treatment plan.
Potential complications include:
- Blood clot that develops in the AV graft and blocks the flow of blood. This may require additional surgery to repair or replace the graft.
- Infection of the graft or skin and tissues around it
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Feeling for the “buzzing” sensation over the graft every day. If there is a change in the sensation or you do not feel it, it may be a sign of a blood clot. Call your doctor right away or go to the emergency room.
Following activity, dietary and lifestyle restrictions and recommendations before surgery, during recovery, and as long as you need the AV graft for dialysis
Informing your doctor if you are nursing or if there is any possibility that you may be pregnant
Keeping the AV graft site clean at all times
Not allowing healthcare personnel to draw blood or take blood pressure readings from the AV graft arm
Not constricting the arm by sleeping on it or wearing tight jewelry or clothing
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Protecting the AV graft from injury and not lifting heavy objects with the AV graft arm
Taking your dialysis treatments and medications exactly as directed
Telling all members of your care team if you have any allergies
Wearing a medical alert bracelet or tag that states you have kidney failure and an AV graft. It should include the graft’s location.
How do I prepare for my arteriovenous (AV) graft surgery?
You are an important member of your own healthcare team. The steps you take before surgery can help improve your comfort and outcome.
You can prepare for arteriovenous (AV) graft surgery by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, previous surgeries, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and type of anesthesia. Preoperative testing may include blood tests, special kidney tests, a chest X-ray, EKG (electrocardiogram), and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
If you have high blood pressure, talk to your doctor about how to control it before and after surgery. Good blood pressure control can help decrease your risk of complications with AV graft surgery.
Not eating or drinking just prior to surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking dialysis treatments and medications exactly as directed
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need AV graft surgery? Are there any other options for creating a dialysis access?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
How do I take care of my AV graft?
When will I start dialysis treatments using the AV graft? How often will I need them?
How do I take my medications?
How will you treat my pain?
When should I follow-up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my arteriovenous (AV) graft surgery?
Knowing what to expect can help make your road to recovery after arteriovenous (AV) graft surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
AV graft surgery is often an outpatient procedure, so you go home the same day. Some people stay in the hospital for other kidney failure treatments. Your surgeon will determine how long you need to stay in the hospital or outpatient center based on your age, condition, and medical history.
Recovery after surgery is a gradual process. Your arm may be sore for several days after surgery. Recovery time varies depending on the procedure, your general health, age, and other factors.
It generally takes two to six weeks for the AV graft to heal enough for dialysis access. Once healed, you will be able to feel a “buzzing” sensation over the graft site. In the meantime, you may need to have dialysis treatments using a temporary venous catheter. This is a tube in your upper chest that connects the dialysis machine to your blood vessels.
Will I feel pain?
Pain control is important to healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after AV graft surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Loss of the “buzzing” feeling in the graft
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might AV graft surgery affect my everyday life?
AV graft surgery can improve the comfort and quality of life for people who need long-term dialysis. AV grafts tend to have more complications, including blood clots and infections, than AV fistulas, another option for dialysis access. However, an AV graft heals faster and can be used more quickly than an AV fistula. With proper care, an AV graft can last several years before needing repair or replacement.
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