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October 23, 1996

Grafts vs Fistulas for Hemodialysis PatientsEqual Access for All?

Author Affiliations

From the Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

JAMA. 1996;276(16):1343-1344. doi:10.1001/jama.1996.03540160065036

Long-term vascular access is required in all hemodialysis patients in order to achieve blood flow rates sufficient for removal of metabolic by-products (eg, urea, creatinine, and other nitrogenous compounds) and excess plasma water. There are 2 principal means of creating permanent vascular access for hemodialysis: an endogenous arteriovenous fistula (also known as a shunt), described initially by Brescia et al,1 using an end-to-side anastomosis of the cephalic vein and radial artery, and a synthetic polytetrafluoroethylene (PTFE) arteriovenous graft, preferably placed in the distal upper extremity. Randomized clinical trial data comparing these 2 types of vascular access have not been performed, but many years of clinical experience and several observational studies have shown a marked increase in the rate of complications and access failure with PTFE grafts, due primarily to repeated bouts of thrombosis and infection.2-5 As of December 1993, only 44% of patients initiating hemodialysis had undergone placement