Upper Extremity AV Grafts

Arteriovenous grafts for permanent arteriovenous access are an important tool in the armamentarium of the vascular access surgeon. This chapter describes how upper extremity exogenous grafts can be placed, and in which situations they make sense over the gold standard of dialysis access, the arteriovenous fistula. The chapter will describe the available materials along with the various configurations of inflow and outflow that can be employed to provide permanent access for the dialysis patient. Grafts designed for immediate access are described, and include both manufactured and biologic materials. In the modern era of pay for performance which requires dialysis centers to meet specific metrics for permanent access, the use of arteriovenous grafts, which can be used more quickly than arteriovenous fistulas, has taken on an increasingly important role. Access providers must consider not only the long-term access requirements of the patient but also factor in the ability to have a functioning access as soon as possible. Understanding upper extremity arteriovenous grafts is essential to the practice of dialysis access surgery.