Graft vs. Fistula

[wcmjt]

I am nearing dialysis and was going to have an AV Fistula but after mapping it was determined I will instead have to have a Graft.  I have some questions about Grafts:  How many of you with grafts have had problems with clotting and what does it entail to fix?  How do you continue dialysis while the clot is being addressed?  How long do Grafts last and when they need to be replaced how is it done while still needing dialysis?  Do they replace the old one and put a new one in the same spot?
Thanks in advance for any help you can give me.
Bill Towns
Polcystic Kidney Disease, Age 71, GFR of 12, On a Transplant list

[GA_DAWG]

I was first outfitted with a fistula, but it did not take, and after mapping it was decided I needed a graft. I had a small amount of trouble with clotting, but not any more than it seemed those with fistulas had. To remove the clot, you go to a vascular center where they in essence do a roto-rooter procedure, and you are back to dialysis the next day. You are lightly sedated for the procedure and it takes very little time. Instead of waiting for a clot, I began scheduling clean-outs every six months that kept it from being an emergency type thing and instead one I could plan on. You must have a driver go with you as you cannot drive after the sedation, and in a clot situation, they have to work you into the schedule, which can mean a long wait. I would rather know the date and time for the procedure. Can't help you with how long grafts last as mine is still the original, though I fear we may be reaching the end of it. My guess is it is like when a fistula stops working and they make another in a different location. There is also the question of how long the scar tissue in the same area will allow for its use.

[jambo101]

 Whats the difference between a graft and a fistula?

[GA_DAWG]

A graft uses an artificial tube to connect the artery and vein, not a direct connection.

[SunshineOfHope2]

I have had to date, 6 surgeries for access. One in the neck, one right chest (failed) one left chest (worked) arm fistula (failed) arm graft (worked 12 sessions) and latest surgery for graft to clean it out. I am a clotter and that is what happens.

How is your access going now? 

[Simon Dog]

Grafts generally last for a couple of years.  My fistula is still humming away one year after getting a transplant and 7 years after initial installation.  I had one fistualagram but all that did was confirm no clots; no problem.  I had a great D team - one day after telling my doc I was having a hard time maintaining a 450 flow (I was on the DIY plan) the vascular surgeon called to ask when I could meet with him.

[kitkatz]

I feel like the red headed stepchild with my big health provider.  Often they forget to call for appointments and I have to be proactive to make my own appointments.  Access problems are raising their heads now.  I made the call to the vascular nurse, went to see her and now am scheduled for an ultrasound next Thursday to see if a Fistulagram with ballooning is necessary.  Here we go again.

[GA_DAWG]

For us, appointments for problems with grafts or fistulas are made by the clinic. Like I knew mine was clotted, but still had to go to the clinic to have them certify it and call the vascular center. The regular appointments every four months are scheduled by the vascular center.

[PrimeTimer]

My husband has had his fistula 6 years now. No major problems. (see edit below) They still use the buttonhole method to cannulate him so no lumps or bumps on his arm. He's on a schedule with the vascular surgeon for a fistula gram every few months and if needed, an angioplasty (balloon job aka roto-rooter). Otherwise, if his clinic suspects a problem they make the appt for him and he's seen pronto. Well, usually in a day or two. They don't sedate him anymore, just numb the area, probe , balloon and one stitch. We believe these balloon jobs have contributed greatly to the life of his fistula. That and being on aspirin therapy and using heparin. 


   Self-edited:

 I incorrectly said he has had no major problems with his fistula. Don't know how I forgot because I'm sure he didn't but one time when he was in the hospital for a fever his fistula formed an aneurism at his arterial buttonhole. It blew open and he was rushed into surgery at 3am. Fortunately there was a good vascular surgeon on-duty. Saved HIM and his fistula!