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OVERVIEW
An arteriovenous (AV) graft is a type of access used for hemodialysis. The graft is usually placed in the arm, but may be placed in the leg if necessary. An AV graft is the connection of a vein and an artery that utilizes a hollow, synthetic tube (the actual “graft”). One end of the tube is connected to an artery and the other end of the tube is connected to a vein. This connection results in blood flowing from the high flow, high pressure artery through the graft and into the low flow, low pressure vein. As a result the blood flow through the graft provides a flow rate that will deliver enough blood to provide an adequate hemodialysis treatment.
INDICATION
While an AV fistula is considered the access of choice by most people in the vascular field, an AV graft is a close second and may be the best choice for certain people. For instance, if the veins are too small for a fistula to properly develop or if the veins are not healthy, a patient would be a better candidate for an AV graft.
If a patient is on dialysis or may be starting in the future, they may be a good candidate for AV graft placement.
PROCEDURE
The AV graft is put in by a vascular surgeon in an operating room. The operation can be carried out using a local anaesthetic (the area is numbed) or general anaesthetic (where you will be asleep). This will depend on your general health at the time.
With local anaesthetic, the blood vessels tend to remain the same size during the procedure. When a general anaesthetic is used, the blood vessels become slightly smaller during the operation. This can make the procedure more difficult. Sometimes it is generally difficult to work with blood vessels that are in poor condition.
The surgeon will:
Make a small cut of about six centimetres long (two inches) in the skin where the graft is to be inserted.
Assess the best artery and vein to use and clamp the blood vessels shut.
Make another cut (six centimetres long) on the side of the chosen artery and vein.
Create a tunnel to thread the graft into the tissues. This will help to keep the graft steady when the wound is healed up.
Stitch one end of the graft to the side of the artery and the other end to the side of the vein.
The surgeon will take off the clamps on the blood vessels and the blood immediately starts to flow straight into the graft.
A larger volume of blood can now flow from the artery directly into the vein. It is this shortcut that makes the graft buzz and vibrate when touched. This is also known as the buzz or the thrill.
The surgeon will test your blood flow while you are still in the operating room.
ADVANTAGES
While an arteriovenous graft is not considered the “gold standard” dialysis access, it’s often considered the next best thing. There are some advantages compared to the other types of hemodialysis vascular access. These advantages of an AV graft include:
An AV graft is usually ready for use within anywhere from a matter of days (for the “early use” grafts) to 3 – 4 weeks of being placed.
An AV graft is easy to implant.
An AV graft has a lower chance of infection than a catheter does.
Once it heals, you can shower.
DISADVANTAGES
Despite the advantages to this type of dialysis access, there are disadvantages as well, which is why it’s not considered the best choice for everyone.
An AV graft doesn’t last as long as an AV fistula does.
Unlike with a catheter, needles are still required to access the AV graft.
AV grafts are more prone to clotting than AV fistulas are.
SURGICAL INSTRUMENTS & O.R. NEEDS
INSTRUMENTS:
AVG Set (the following instruments included in this set are as follows):
Mayo Curve/Mayo Straight
Metz Curve
Tenotomy Curve
Knife Handle
Mosquito Curve/Mosquito Straight
Mixter
Towel Clips
Debakey Forceps
Adson Forceps
Gerald Forceps
Needle Holder
Ryder/Castroviejo
Dilators
Bulldog Curve
Army Navy
Senn Retractor
Small Weitlaner
Kidney Basin
Small Bowl
Pott’s Scissors
Tunneler with Heads
EXTRA Gerald Forceps
EXTRA Senn Retractor
EXTRA Small/Medium Weitlaner
EXTRA Castroviejo
O.R. NEEDS:
Operating Sponge
Gloves 6, 61/2, 7 and 71/2
Syringes (1cc and 10cc)
Cautery Cord (short tip)
Feeding Tube Fr. 8 (for shudding of mosquitoes)
Cautery Pad
IV Cannula G20
Blade 11 and Blade 15
Lidocaine 2%
Heparin
Tegaderm (small/medium)
Tourniquet (optional/standby)
Marker (optional/standby)
Povidone Iodine 7.5%
Povidone Iodine 10%
Alcohol
Silk 2.0 and Silk 4.0 (strands)
Prolene 5.0 RB2/Prolene 6.0 BV1
Prolene 7.0 BV1 (optional/standby)
Vicryl 4.0 PC5/ Vicryl 4.0 RB1
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