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October 23, 1996

Grafts vs Fistulas for Hemodialysis PatientsEqual Access for All?

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