AV Graft Surgery Melbourne
An arteriovenous graft (AVG) is a synthetic tube, typically made of polytetrafluoroethylene (PTFE), surgically placed to connect an artery to a vein for haemodialysis access. AVGs are used when a native arteriovenous fistula cannot be created due to inadequate veins or after failed fistula attempts. The graft provides a reliable conduit for dialysis needling and can be used sooner than a native fistula. While AVGs have higher complication rates than native fistulas, they remain a valuable option for patients who would otherwise require long-term catheter use.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- Provides dialysis access when native fistula is not possible
- Can be used earlier than native fistula (2-4 weeks vs 6-12 weeks)
- Easier to cannulate due to consistent size and position
- Good functional lifespan with proper care (2-5 years average)
- Can be placed in various configurations (arm, thigh, chest wall)
- Preferable to long-term catheter use
- Can be revised or extended if problems develop
The Procedure
AVG placement is performed under local anaesthesia with sedation, regional block, or general anaesthesia. The graft is tunnelled under the skin between an artery and vein, commonly in the forearm or upper arm. Common configurations include forearm loop graft and upper arm straight or loop grafts. The synthetic tube is sewn to the artery and vein at each end. The procedure takes 1-2 hours. The graft can typically be used for dialysis after 2-4 weeks, once swelling has settled and the tissue has incorporated around the graft, though some early-cannulation grafts can be used within days.
Who Is a Candidate?
AVG placement is recommended for dialysis patients whose native veins are unsuitable for fistula creation, those with failed previous fistula attempts, patients needing urgent access who cannot wait for fistula maturation, and those with exhausted upper limb access options (thigh grafts available). Preoperative assessment includes ultrasound vein mapping and arterial evaluation. While fistula remains the preferred first option, a well-functioning graft is far superior to long-term catheter dependence for dialysis.
Recovery
AVG placement is usually a day surgery procedure. Expect arm swelling and discomfort for several days - keep the arm elevated and use prescribed pain relief. Avoid heavy lifting or strenuous use of the arm for 2 weeks. The graft can typically be used for dialysis after 2-4 weeks once tissue incorporation has occurred. Monitor for signs of infection (redness, warmth, discharge) or clotting (loss of thrill/buzzing sensation). Protect the graft from trauma and avoid blood pressure measurements or blood draws from that arm.
Risks & Considerations
AVG complications are more common than with native fistulas. Risks include thrombosis (clotting) - the most common problem requiring intervention, infection (higher risk than native fistula, may require graft removal), stenosis (narrowing) at the vein end requiring angioplasty or revision, seroma (fluid collection around graft), pseudoaneurysm formation at cannulation sites, steal syndrome (hand ischaemia), and graft degradation over time. Regular monitoring and prompt treatment of complications can extend graft lifespan. Average patency is 2-5 years with appropriate interventions.