What is a synthetic graft and why is it not the optimal type of dialysis access?
A synthetic graft (e.g., GORETEX graft) is created by the surgical interposition of a synthetic blood vessel between an artery and a vein. Both the AV fistula and the synthetic graft are below the skin.
An AV fistula is preferred over a synthetic graft because the AV fistula has fewer complications and a longer primary patency rate (intervention free access survival) and secondary patency rate (access survival until abandonment).
Specifically, there is a much higher rate of intimal hyperplasia at the vein anastomosis in grafts versus fistulas, resulting in stenosis and ultimately obstruction with thrombosis.
Grafts also have higher infection rates due to the presence of a foreign body. Nonetheless, about 30% to 50% of fistulas that are placed are abandoned prior to use due to thrombosis, inadequate blood flow, or complications from access placement.
