Duke vascular surgeons create safe, long-term hemodialysis access for people with kidney failure. We work with your nephrologist to determine what type of access is right for you. Our experts use the most advanced vein mapping technology and surgical techniques to care for all dialysis patients, whether you are just starting dialysis or have a highly complex case.
Hemodialysis is one of two types of dialysis. It requires frequent access to your bloodstream to withdraw your blood, filter it through a machine, and return it to your body. This process occurs several times a week and takes about five hours each session. It’s important that this access point is durable to make dialysis easier and more efficient.
Peritoneal dialysis is the second type of dialysis. It requires a catheter that is placed by general surgeons or interventional radiologists.
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There are two main types of hemodialysis access: arteriovenous fistula and arteriovenous graft.
An AV fistula is the preferred option for hemodialysis access. To create an AV fistula, a vascular surgeon connects an artery to a vein, usually in the wrist, elbow, or armpit.
Veins, which transport deoxygenated blood back to the heart, carry a smaller volume of blood than arteries, which transport oxygenated blood from the heart to the body. When a vein and an artery are connected, the increased blood flow expands and strengthens the vein. This creates a reliable and large source of blood and enables the vein to withstand repeated needle access. It usually takes six to twelve weeks for the vein to be fully mature and ready for dialysis to begin.
AV fistulas can last for up to 10 years and have lower rates of infection and blood clots compared with AV grafts.
AV grafts are usually reserved for people who are not candidates for an AV fistula due to poor blood vessel health, older age, or an urgent need to start dialysis.
Vascular surgeons create an AV graft by using a tube to connect an artery and a vein in the arm. The tube is often U-shaped or C-shaped and may be man-made, or it can be a blood vessel harvested from another place in your body or from an animal. You may also be eligible to receive a new type of graft currently being studied in clinical research. Each type of graft generates a dependable source of blood, and the tube is sturdy for repeated needle access.
AV grafts last about five years. Unlike AV fistulas, AV grafts are usually ready for use in a few weeks. An early cannulation arteriovenous graft (ecAVG) can be used in as little as 24 hours.
Compared with AV fistulas, AV grafts are more likely to develop blood clots or become infected.
Ideally, your primary care doctor or nephrologist will refer you to a vascular surgeon for hemodialysis access evaluation months before you need to start dialysis. Otherwise, your access options may be limited.
Sound waves create images of your veins and arteries. This allows vascular surgeons to measure your blood vessels, understand your unique anatomy, and identify which vessels should be used for hemodialysis access.
You will meet with your vascular surgeon, usually on the same day as your vein mapping ultrasound, to discuss your hemodialysis access options and choose the one that is best for you.
You will undergo simple tests to ensure you are healthy enough to undergo surgery. Tests may include blood work and an electrocardiogram (EKG) to evaluate your heart.
Your surgery will take place in an operating room at one of Duke’s hospitals in Durham or Raleigh. Rather than general anesthesia, an anesthesiologist will administer a regional pain block and moderate sedation, putting you in a twilight-like state during the procedure. AV fistula and AV graft surgeries usually last one or two hours. Most people can go home the same day, although people with more complex health conditions may need to stay overnight for monitoring.
Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2025–2026.
Duke’s vascular surgeons perform hundreds of hemodialysis access procedures each year. Research shows that hospitals and surgeons who perform more surgeries tend to have better outcomes. Our experience helps ensure you get the best results.
Unlike smaller, standalone dialysis access clinics, Duke’s vascular surgery program brings together a team of experts who routinely help people experiencing hemodialysis vascular access complications or failures. We use the most advanced vein mapping technology to identify and establish other access sites, even in people with serious health problems.
Our vascular surgeons work closely with nephrologists to prioritize your kidney health. We also collaborate with interventional radiologists, who perform minimally invasive catheterization procedures to repair connections and remove blood clots that can form in or near AV fistulas and AV grafts.
