Kidney doc wants fistula yesterday, vasc doc said graft and can wait

[ODAT]

Rizk (vascular) said that Dahaan (kidney) called him and said if it is a fistula - do it yesterday. Rizk said a fistula cannot be done as mom's veins are too small. So the alternative is a graft which takes 3 weeks to mature and be ready to use for dialysis. He said that from the time he gets the call to place the graft to when it was ready to be used, it would be about 6 weeks. If mom needed dialysis before then, they would put a chest catheter in and remove it once the graft was working. She would not be able to get it wet and there is a risk of infection. He told us this because I told him that she would like to wait until after healing from the knee surgery. And that wouldn't be until July 7 due to the Plavix. He is concerned and would take extra precautions when doing the graft surgery with the extra blood flow. He said Plavix would not prevent the surgery from happening.

I told Rizk I was concerned with the urgency Dahaan seemed to have when he had told us that she would probably need dialysis in about a year. I can understand that if a fistula was going to be used since it takes about 4 months to mature, but now that we know it's a graft, I don't see the urgency. I also said that mom doesn't appear to be any sicker and Rizk said when you go see Dahaan, see how the numbers are. If they went down, we should think about doing the graft. If the numbers are the same or better, we can wait. I told him that mom isn't showing any signs of getting worse. And he said if she starts getting more tired, short of breath that would be one of the few things to watch for.

Rizk showed us the plastic tube that would go in mom's lower arm. Mom asked if there would be a bump and he said there is always a bump and sometimes a golfball-sized one. He said that compared to a fistula which can last many years, a graft can sometimes only last 6 months. But, I see from here that some people have successfully used the same one for two to six years.

Next step is to go to the appointment with Dahaan on January 16 and see what her numbers are.

Had to add that the vascular doctor asked my mother if she was a candidate for a transplant?! I said they told her she was too old. He asked her how old she was and told him she'd be 75 in February. Hello, can anyone read the chart!?

[jbeany]

There's two things they are not telling you. The first is that the problem with thinking she won't need dialysis for a year is that they can't really do more than guess.  Her numbers might hold steady for three or four years, or she might rapidly get worse and need dialysis in a few months.  The second is that the estimates on time for a graft to heal are all dependent on the graft actually working from the start.  They may have to make more than one attempt.  My doc started me on a course of surgery to get a fistula at the "year to go" point as well.  I didn't actually start for almost two years.  It took about 6 months to actually get a working graft, though.  The first fistula attempt wasn't successful at all - they just opened my wrist to look at the veins, sliced up my nerves, and didn't actually do a fistula at all.  The first graft failed after 3 days.  We spent a while messing around trying to fix that before giving up and putting in another.  They want to start early in case they screw it up!

[bhall777]

Grafts dont need time to mature. Grafts are ready to be used as soon as the swelling from the surgery goes down. I used my graft within a week of surgery.