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Difference Between Fistula and Graft
Fistula and graft are both types of vascular access used in patients with end-stage renal disease (ESRD) who require hemodialysis. Hemodialysis is a medical procedure that filters waste products from the blood in patients with kidney failure. Fistula and graft are created to provide access to the bloodstream for hemodialysis. Although both fistula and graft serve the same purpose, there are significant differences between the two. In this essay, we will discuss the differences between fistula and graft.
What is Fistula?
A fistula is created by connecting an artery to a vein, usually in the forearm. The fistula is created by surgically joining the artery and vein together, allowing the blood to flow directly from the artery into the vein. Over time, the fistula becomes thicker and more durable, allowing for easy access for hemodialysis. Fistula is considered the gold standard for vascular access in patients with ESRD. The advantages of fistula are numerous, including fewer complications such as infection and thrombosis, longer lifespan, lower cost, and better blood flow rate during hemodialysis. Additionally, fistula has a lower risk of infection than graft.
Where it is formed − Surgeons create the fistula connection between a vein and artery in the lower arm of a person needing hemodialysis for kidney treatment. The procedure is done in an outpatient setting, often, and it takes a few months before it can be used for the hemodialysis.
Advantages of an AV fistula − Some advantages of using an AV fistula for dialysis patients is that it decreases the chances of blood clots forming. It also reduces the risk of infection and enables a good flow of blood for the dialysis procedure. A study showed that infection rates were about 0.9% for patients with an AV fistula which is much lower than the average 9% infection rate of grafts. This form of vascular access is often the first type that a doctor will try in patients who need to have dialysis.
Disadvantages of an AV fistula − The fistula takes quite a long time to fully develop such that it can be safely used for dialysis. This may mean the person has to rely on having a central venous catheter for a longer period of time than if they had a graft in place.
What is Graft?
Graft, on the other hand, is created by using a synthetic tube or a piece of bovine or human tissue to connect an artery and a vein. Graft is often used when the patient’s veins are not suitable for fistula creation. Graft has several advantages over fistula, including easier and quicker access for hemodialysis, and can be created in areas where fistula is not possible, such as in the upper arm. However, graft has a shorter lifespan than fistula and is more prone to complications such as infection and thrombosis.
Where it is formed − The graft is placed between an artery and vein in the lower arm of the patient by a vascular surgeon. The procedure is often done on an outpatient basis and the graft can be used within a few weeks for dialysis.
Advantages of an AV graft − An AV graft is a good and viable alternative to a fistula in patients who are unable to have an AV fistula for one reason or another, or if the fistula fails. The AV graft can also be used relatively quickly, within a few weeks, and is ready much sooner than is a fistula. Scientists have found that it is a good alternative for vascular access when patients can’t have a fistula procedure done.
Disadvantages of an AV graft − Scientists have found that using an AV graft has a higher risk of blood clots forming than if a person uses an AF fistula. The graft also seems to be associated with a greater risk of infection, hospitalizations and even death among the elderly (persons over 70 years of age). Studies have found infection rates of up to 9.5% in patients with AV grafts.
Differences: Fistula and Graft
One of the primary differences between fistula and graft is their lifespan. Fistula has a longer lifespan than graft, with an average lifespan of 5 to 10 years, while graft has a lifespan of 2 to 4 years. Fistula is also less prone to complications, with a lower risk of infection, thrombosis, and other complications associated with graft.
Another significant difference between fistula and graft is the ease of use for hemodialysis. Graft can be used for hemodialysis soon after the surgery, while fistula requires time to mature and become durable enough for hemodialysis. Fistula can take up to three months to mature, while graft can be used immediately after the surgery. However, fistula provides better blood flow rate during hemodialysis than graft.
Cost is another factor to consider when choosing between fistula and graft. Fistula is less expensive than graft since it requires only surgical intervention and doesn’t involve the use of synthetic materials. Graft, on the other hand, is more expensive than fistula since it involves the use of synthetic materials.
The following table highlights the major differences between Fistula and Graft −
Characteristics |
Fistula |
Graft |
|---|---|---|
Definition |
A fistula is some type of connection that is formed between an artery and a vein. |
A graft is a connection that is made using plastic to connect a vein and an artery. |
Plastic piece is inserted |
A piece of plastic is never used to connect a vein to an artery in a fistula. |
A piece of plastic is always used and it is usually of polytetrafluoroethylene plastic, to connect a vein and an artery in a graft. |
How soon it can be used |
A fistula can only be used after a few months for dialysis |
A graft can be used for dialysis within a few weeks. |
Risk of infection |
The risk of getting an infection using a fistula for dialysis is lower. |
The risk of infection when using a graft for dialysis is higher. |
Risk of blood clots |
A fistula has a lower risk of blood clots for dialysis patients. |
A graft has a higher risk of blood clots for dialysis patients. |
Mortality rate for elderly patients |
An AV fistula has a lower mortality rate for elderly dialysis patients. |
An AV graft has a higher mortality rate for elderly dialysis patients. |
How long it lasts for |
In general, the AV fistula lasts longer. |
In general, the AV graft does not last as long as the fistula. |
Conclusion
In conclusion, Fistula and graft are two types of vascular access used for hemodialysis in patients with end-stage renal disease. Although both fistula and graft serve the same purpose, there are significant differences between the two.
Fistula is considered the gold standard for vascular access in patients with ESRD due to its longer lifespan, fewer complications, lower cost, and better blood flow rate during hemodialysis.
Graft, on the other hand, is used when the patient’s veins are not suitable for fistula creation, and it has advantages such as easier and quicker access for hemodialysis, and can be created in areas where fistula is not possible. However, graft has a shorter lifespan than fistula and is more prone to complications such as infection and thrombosis.
The choice between fistula and graft depends on the individual patient’s condition, the availability of veins, and the surgeon’s recommendation.
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