Graft for Dialysis: I'm getting ready for... - Kidney Disease

Kidney Disease

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Graft for Dialysis

Rognoni profile image

I'm getting ready for dialysis. My vascular surgeon told me that my veins are too small for AV Fistula. He recommended that, although difficult to predict, I should wait until I'm ready to start dialysis and just about one month prior to that I should have a Graft put in, ready to be used for dialysis. I'm afraid that I may not catch it on time and wind up needing a catheter through the neck which I'd like to avoid. Has anyone had a Graft rather than a Fistula? What are the disadvantages of a Graft? Is there any way to make the veins bigger to qualify for a Fistula? (Some kind of exercise, etc.) Please comment. I was also told that because of my prior prostate surgery and two prior hernias I may have difficulty with the PD modality. My creatinine is 4.1 and my GFR is 13, I think it's time to take action. Any remedy or suggestions is appreciated. Thank you.

18 Replies

Has the vascular surgeon you spoke to had prior success with the graft surgery? I'd be reluctant to use a surgeon with a limited success/experience history.I do agree with you that I'd prefer to have the surgery sooner than later. It is up to you.

Best of luck.

Sorry to hear that your getting close to ESRD. I reached ESRD last August. Like you, my veins were, quite likely, too small for the AV fistula. I wasn’t terribly wild about the graft so I went with a PD catheter. BTW, I had previously had abdominal surgery due to stage 1 colon cancer. Surprisingly, the catheter worked well for the five weeks I needed it — the stars aligned and I received a living donor kidney in September.

Remember, no matter what type of dialysis you receive, it is life saving technology. For me, my BUN dropped from 100 to 40 within a few weeks. As a result, I felt much, much better.

I’m also interested in knowing if there’s a way to increase size of veins (eg excercises).

Christopher

Rognoni profile image
Rognoni in reply to shadowfax001

Thank you Christopher, great information. Glad to hear about your transplant.

shadowfax001 profile image
shadowfax001 in reply to Rognoni

Like I said, I interested in methods to increase vein size. I found a 2003 article "These findings indicate that a simple, incremental resistance, exercise-training program can cause a significant increase in the size of the cephalic vein commonly used in the creation of an arteriovenous fistula. The increase in size and resultant probable increase in blood flow might accelerate the maturation of native arteriovenous fistulae." And, that was just a cursory search — I clicked on the first link. :-)😀

Rognoni profile image
Rognoni in reply to shadowfax001

Thanks Christopher, would you elaborate on the type of "incremental resistance" exercise. How is it done?

My son started one month ago , he had the ine in the neck because his veins are too small/ thin . That’s a bit of a problem as it’s held in position with a stitch which can’t go too deep.Monday he will have the one that goes down the right side of his chest ( is that what you call a graft?)dr says it’s better than the one in the arm.

My late husband had the one in the arm & he always complaine that the dialysis is painful at the start of the treatment.

My understanding of the one in the chest is that it’s under the skin.

Good luck

Rognoni profile image
Rognoni in reply to Amrellessy66

Thank you

KidneyCoach profile image
KidneyCoachNKF Ambassador

There is a neck catheter which is temporary. Then there is a tunneled chest catheter which should be temporary but often is not. It allows for a cuff that tissue grows around it helping to stabilize it. The one wind comes out through chest going under skin up to jugular vein, into vein and ending into the heart. These can be used immediately.

There are AV fistulas which require maturation of both enlargement of vein and thickness of wall (usually takes weeks or months).

Grafts are like AV fistulas (in arms or legs) but are usually synthetic material which cannot be stuck in same place and need replaced after time (years). They can be used within a few days.

There are also femoral catheters and tunneled femoral catheters and AV fistulas and grafts in the leg.

The AV fistula is the ideal access, but anything that works is a lifeline.

Hope this helps. Blessings

Rognoni profile image
Rognoni in reply to KidneyCoach

Thank you for the detailed description; great information.

I had a neck”chest” catheter worked great for 4 years in clinic ask where it located and mention chest catheter 💚

Thank you for your positive feed back. I had heard mostly negative consequences with chest catheter.

Im in Canada i know the doctors don't like chest cath its is a higher risk however if you are dedicated to keep it clean and not wet you will do fine most people don’t like because you are told not to take shower no big deal wash hair and clean with face cloth💚💚💚 05/24/2018 haven't looked back 💚

Thank you. Sounds very encouraging, relieving! Had you first considered the Fistula or the Graft? Have you also considered Home PD? Thank you for your valuable feed back.

I started on PD at home for 4 years then had to move to in clinic hemo chest cath and no because i had seen what is does to your arm it terrible my doctor wanted me to get fistula i refused so he stitched my cath in more permanently and did wanr me he could not guarantee how long it would last it brought me all the way to my transplant 4 years lated 🙏💚 i do know a lot of people who had issues wit cath its not for every one but i was willing to try🙏🙏💚

If it's not too personal, why did you decide to stop PD at home to go to chest catheter. I'm asking because I have considered PD, still not totally convinced on which modality to take. Thank you, you've been very kind.

After 4 years doing P D i became careless and ended up with infection in my line 💚💚💚

Thanks again, you've been very helpful

💚💚💚

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