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February 12, 1997

Vascular Access in Patients Receiving Hemodialysis

JAMA. 1997;277(6):455. doi:10.1001/jama.1997.03540300023012

To the Editor.  —The increasing use of arteriovenous (AV) grafts compared with fistulas in the United States reported by Dr Hirth and colleagues1 is all the more surprising given the increased availability of a dialysis catheter with the subcutaneous tunnel (Perm catheter, Quinton, Seattle, Wash). Fistulas generally require 6 to 12 weeks to "mature," which is 3 to 4 times longer than grafts.2 Dialysis is needed during the interim, especially among the late-referred patients. A tunneled catheter is preferable for longer-term "temporary" access. The increased availability of this type of catheter between 1986 and 1990 would presumably have allowed the permanent access more time to mature and, hence, would have favored arteriovenous fistula (AVF) placement over AV graft placement.In addition, Hirth et al1 mention that in Japan 100% of patients newly treated with hemodialysis receive a fistula as their first method of access. Is there a