In Patients with Threatened or Occluded Dialysis Access Grafts, Is It Better to Salvage the Graft, or Create a New Site?

Threatened or occluded access grafts are a frequent complication in patients undergoing hemodialysis and are associated with increased length of stay, morbidity, mortality, and hospital costs. An ideal access is one that can be reliably developed, delivers an optimal dialysis dose, and is resistant to thrombosis, infection, and the need for re-intervention. Access grafts generally have a greater likelihood to initial successful use and greater success for access salvage, but are prone to frequent failure and shorter long term patency. Arteriovenous fistula, however, are associated with lower likelihood to initial successful use, but have longer patency rates with fewer long term complications. When faced with a threatened graft and a secondary arteriovenous fistula is feasible, the best management approach may be an intervention to initially save the threatened graft but plans should be in place to perform a secondary arteriovenous fistula. If a secondary arteriovenous fistula is not performed prior to the third intervention to save the threatened graft, likelihood of a successful conversion to a secondary arteriovenous fistula decreases.