AV Graft Results

The literature describing results of AV grafts is surprisingly sparse with a dearth of randomized controlled trials and wide variance in methods and descriptions. Nevertheless, we can conclude that grafts are better than catheters. They are actually equivalent to fistulas with regard to secondary functional patency, with the caveat that this outcome requires more interventions to maintain and at a higher cost. The type of graft material or configuration does not seem to make a significant difference. Early cannulation grafts perform equivalently to standard graft material but may allow one to avoid tunneled catheter placement. Medications, unfortunately, do not seem to make much of a difference in graft patency. What is the future of AV grafts? As the prevalence of dialysis increases and the age of patients’ progress, it is probable that the need for grafts will continue to increase as well. Ideally, grafts will become more resistant to injury, easier to place, and ready to be used immediately in all cases. If a graft can be used immediately in all cases, the paradigm may change. Instead of 80% (in the United States) of patients being initiated on dialysis with tunneled dialysis catheters, grafts could be used in their place. Fistulas remain the “best” access in most cases, but grafts have a critical role as well.