Fistulas vs Grafts: What Are the Outcomes?

Autologous arteriovenous fistulas (AVFs) are generally the preferred type of vascular access because once cannulated for dialysis, AVFs have better survival and require fewer interventions to maintain long-term patency for dialysis and incur fewer infections. A high proportion of AVFs, however, fail to mature adequately to be used in dialysis. This will translate in more procedures to promote maturation and prolonged central venous catheter (CVC) time with associated increased infections, cost, hospitalizations, and mortality. The decision is thus more complex than just a blind adherence to “fistula first,” and must take into consideration the individual patient characteristics, including age, gender, life expectancy, and many other factors.