Interventional nephrology: When should you consider a graft?

The patient's vascular access is critical in ensuring that hemodialysis is successful, effective, relatively uncomplicated, and consistently reproducible from one treatment to another. The choice of vascular access is dictated by a multitude of factors, some of which are generalizable to a larger system, and others of which are flavored by local experience and expertise; an important fraction is specific to the patient presenting to the clinician at a particular point in time. Some of these factors, such as patient age and sex, are not modifiable; others, like comorbidity, vessel size and urgency of presentation to the renal provider, are manageable and sometimes modifiable. The role of the autologous arteriovenous fistula as the ideal conduit for hemodialysis treatments is well established. The role of the prosthetic graft warrants discussion and investigation to most optimally apply to patients this important alternative within the armamentarium of vascular access.