[Vascular grafts as access for hemodialysis]

Area of Science:

• Vascular Surgery
• Nephrology
• Biomaterials

Background:

• Prosthetic arteriovenous grafts (AVGs) offer an alternative vascular access for hemodialysis when autogenous options are unsuitable.
• AVGs are associated with lower patency rates and higher morbidity compared to autogenous fistulas.
• They are typically considered for secondary or tertiary access in patients with exhausted superficial arm veins.

Purpose of the Study:

• To review the indications for prosthetic arteriovenous grafts in hemodialysis.
• To discuss alternative configurations and characteristics of AVGs.
• To highlight the role of AVGs in contemporary vascular access surgery.

Main Methods:

• Literature review of studies on prosthetic arteriovenous grafts for hemodialysis access.
• Analysis of factors influencing AVG patency and morbidity.
• Comparison of AVGs with autogenous fistulas and tunnelled cuffed catheters.

Main Results:

• Prosthetic AVGs have inferior patency and greater morbidity than autogenous vessels.
• Careful pre-operative planning, surgical technique, and complication management are crucial for long-term AVG function.
• A variety of prosthetic conduits are available for AVG creation.

Conclusions:

• Arteriovenous grafts remain essential for hemodialysis vascular access, particularly in patients with complex venous anatomy or comorbidities.
• Their role may expand with increasing patient comorbidities.
• AVGs should be preferred over tunnelled cuffed catheters when feasible.