Dialysis Graft (AV Graft): How It Works, Surgery, Recovery and Risks
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is a dialysis graft?
A dialysis graft is a hollow tube that a specialist uses to connect an artery to a vein, usually in the arm, so needles can reach the bloodstream during hemodialysis. It is placed under local anesthesia, is usually ready in about three weeks and lasts about two to three years. It is a good option when a fistula isn't possible. [1]
What the research says
Fistulas stay open longer than grafts. A pooled analysis of 200 studies covering 875,269 dialysis accesses found that 55% of fistulas, 50% of catheters and 40% of grafts were still working without a repair procedure at 2 years; 2-year death rates were 15%, 26% and 17%, respectively. (Almasri et al., J Vasc Surg, 2016) [2]
A graft is a safer choice than a catheter. In 62 cohort studies with 586,337 people, catheter users had a 38% higher risk of death and a 49% higher risk of fatal infection than graft users. Graft users, in turn, had an 18% higher risk of death and a 36% higher risk of fatal infection than people with fistulas. These were observational studies with a high risk of bias. (Ravani et al., J Am Soc Nephrol, 2013) [3]
The newest pooled data point the same way. A meta-analysis of 63 studies and 357,333 patients found that, at 1 year, fistulas had 61% higher odds than grafts of staying open without intervention (OR 1.61) and had about half the odds of complications (OR 0.52); early failure and revision rates did not differ. (Yang et al., BJS Open, 2026) [4]
Key takeaways
A dialysis graft (arteriovenous or AV graft) is a tube that joins an artery to a vein to create a reliable access point for hemodialysis. [1]
It is a minor, same-day procedure done under local anesthesia, and the graft is usually ready for use in about three weeks. [1]
A fistula remains the first choice; a graft is the next best option, especially when veins are small or weak. [1]
Grafts last about two to three years on average and carry a higher infection risk than fistulas. [1]
A gentle buzz over the graft is normal. No buzz, bleeding, swelling, warmth or pain means you should call your care team. [1]
What is a dialysis graft and how does it work?
A dialysis graft is a soft, hollow tube placed under the skin to connect an artery to a vein so that the bloodstream can be reached easily for hemodialysis. [1] Another name for it is an arteriovenous (AV) graft. [1]
Hemodialysis is a treatment for people whose kidneys no longer work well enough. A machine draws blood out of the body, filters out waste and returns the cleaned blood. [1] To do this safely, the care team needs an access point with strong, steady blood flow.
That is where the graft helps:
Arteries carry a large volume of blood at high pressure.
Veins carry blood at lower flow and pressure.
The graft links the two, creating the flow and pressure that hemodialysis needs. [1]
During each session, the dialysis needles go into the graft itself rather than into a blood vessel. [1]
Who needs a dialysis graft?
A dialysis graft is for people with kidney failure who are preparing to start hemodialysis and who cannot have a dialysis fistula. [1] It is often chosen when a person's veins are too small or too weak to form a fistula. [1]
Getting a graft is one of the steps taken before hemodialysis begins. It is a small procedure, but it supports a serious treatment. [1]
How is a dialysis graft different from a dialysis fistula?
A dialysis graft uses a tube to join an artery and a vein, while a dialysis fistula joins the artery directly to the vein. [1] A fistula is the safest and most effective access for hemodialysis. It usually lasts longer and has a lower infection risk, so a graft is not considered better than a fistula. [1]
Feature | Dialysis graft (AV graft) | Dialysis fistula (AV fistula) |
How it connects | A soft tube joins the artery to the vein [1] | The artery is joined directly to the vein [1] |
Best suited for | People whose veins are small or weak [1] | First choice for hemodialysis access [1] |
How long it lasts | About 2 to 3 years on average [1] | Usually longer than a graft [1] |
Infection risk | Higher [1] | Lower [1] |
Still working without repair at 2 years | About 40% [2] | About 55% [2] |
What happens during dialysis graft surgery?
Dialysis graft surgery is a minor procedure in which a specialist stitches a tube between an artery and a vein, usually in the arm you don't write or eat with. [1] In some cases, the graft is placed in the leg instead. [1]
How do you prepare for the procedure?
Before the procedure, your care team may ask you to:
Arrange for a family member or friend to drive you home
Remove jewelry, including bracelets, watches and fitness trackers
Wear loose, comfortable clothing that is easy to change out of
Pause medicines that raise bleeding risk, such as NSAIDs, blood thinners and some herbal supplements [1]
Only stop a medicine if your care team tells you to. [1]
What are the steps of the surgery?
You stay awake during the surgery. The area is usually numbed with local anesthesia. [1] The specialist then:
Makes two small cuts (incisions) to reach an artery and a vein
Stitches one end of the graft to the artery
Stitches the other end of the graft to the vein
Closes the incisions with stitches and covers them with bandages [1]
What types of dialysis grafts are there?
There are two main shapes of dialysis graft: straight and looped. [1]
Graft type | Shape | Key point |
Looped graft | Curved like a hairpin, with a ring that supports the bend | The ring helps stop the tube from twisting and pinching shut (kinking) [1] |
Straight graft | A straight tube between the artery and vein | May be more likely to kink than a looped graft [1] |
Who performs a dialysis graft, and how long does it take?
A vascular surgeon or an interventional radiologist usually places a dialysis graft. [1] Vascular surgeons treat conditions of the blood vessels, while interventional radiologists use imaging and small devices to diagnose and treat disease. [1]
The surgery usually takes a few hours, and most people go home the same day. [1] Plan for someone else to drive you. [1]
What are the benefits and risks of a dialysis graft?
A dialysis graft offers quick, reliable hemodialysis access for people who can't have a fistula, but it carries risks such as clots, infection and steal syndrome. [1]
Benefits | Risks |
A good alternative to a fistula when veins are small or weak [1] | Blood clots that slow or stop blood flow (learn about blood clots) [1] |
Usually ready for dialysis a few weeks after the procedure [1] | A bulge in the artery wall (aneurysm) [1] |
Recovery is often quick and easy [1] | A higher chance of infection at the access site [1] |
Steal syndrome: the graft diverts blood away from the hand or foot of that limb [1] |
Compared with a dialysis catheter, a graft is linked to a lower risk of death and fatal infection, while a fistula carries the lowest risk of all. [3]
Does a dialysis graft hurt?
A dialysis graft usually causes some pain, bruising and swelling in the arm for several days after surgery. [1] NSAIDs or acetaminophen can ease the pain, but not everyone can safely take them, so check with your care team first. [1]
To limit swelling, keep your elbow straight and rest the arm raised on a few pillows. [1]
How long does dialysis graft recovery take?
A dialysis graft is usually ready for hemodialysis about three weeks after the procedure, although some people heal faster or slower. [1] Your care team will tell you what to expect in your case.
Once the area heals, you should feel a gentle vibration, buzz or pulse when you touch the graft, a bit like a purring cat. This is a good sign: it means blood is flowing through the graft. [1]
How can you protect your dialysis graft while it heals?
These habits help your arm heal and protect the graft [1]:
Do | Avoid |
Let someone else drive you when you need to go out | Driving yourself |
Wash gently with soap and water, then pat dry | Swimming |
Cover the arm in plastic when you shower or bathe | Getting the site wet |
Squeeze a stress ball to ease hand numbness or coldness and strengthen the access | Sleeping on the graft arm |
Wear a pad or arm guard against accidental bumps | Tight clothing or jewelry on that arm |
Lifting more than 10 pounds (4.5 kg), about a gallon of water |
Squeezing a stress ball also helps build a stronger access, which makes hemodialysis faster and easier and helps prevent clots. [1]
How long does a dialysis graft last?
A dialysis graft lasts about two to three years on average; it is not permanent. [1] When a graft stops working, you may need a procedure to remove a clot, or the graft may be replaced or placed somewhere else in the body. [1]
Large studies confirm that grafts stay open for a shorter time than fistulas. About 40% of grafts were still working without a repair procedure at 2 years, compared with about 55% of fistulas. [2]
When should you call a doctor about a dialysis graft?
Call your care team if you can't feel the usual vibration in your dialysis graft, or if you think the graft has been damaged. [1] Watch for:
More bleeding than usual at the graft site
Bruising
Bulging around the graft
Discoloration or warmth
Pain
Swelling [1]
Conclusion
A dialysis graft is a small procedure with a big job. It gives your care team a dependable way to connect you to the dialysis machine when a fistula isn't an option. [1] Most grafts are ready in about three weeks and last two to three years, and simple daily care helps them work well for as long as possible. [1]
Feeling worried about the surgery, about damaging the graft or about how long it will last is completely natural. It is a big change. Bring every question to your care team. [1]
Keep learning with Rinnit: Read our guide to the dialysis fistula to compare your access options, then explore the 5 stages of chronic kidney disease and our guide to peritoneal dialysis. Share this guide with a family member who is supporting you through dialysis.
FAQ
What is a dialysis graft?
A dialysis graft is a soft, hollow tube that connects an artery to a vein so needles can reach the bloodstream for hemodialysis. It is also called an arteriovenous (AV) graft. [1]
Is a dialysis graft better than a fistula?
No. A dialysis fistula is the safest and most effective access for hemodialysis, lasts longer and has a lower infection risk. A graft is a good alternative when a fistula isn't possible. [1]
How long after graft surgery can I start dialysis?
Most dialysis grafts can be used about three weeks after the procedure. Healing time varies, so your care team will confirm when your graft is ready. [1]
How long does a dialysis graft last?
A dialysis graft lasts about two to three years on average. When it stops working, a clot may be removed or the graft may be replaced or moved. [1]
Does dialysis graft surgery hurt?
You stay awake, but the area is numbed with local anesthesia. Afterward, pain, bruising and swelling in the arm are common for several days. [1]
Is it normal to feel a buzz in my dialysis graft?
Yes. A gentle vibration, buzz or pulse over a healed graft means blood is flowing through it. If you can't feel it, call your care team. [1]
What are the main risks of a dialysis graft?
The main risks of a dialysis graft are blood clots, an aneurysm, infection at the access site and steal syndrome, where blood is diverted away from the hand or foot. [1]
When should I call a doctor about my dialysis graft?
Call your care team if the vibration in your graft stops or if you notice unusual bleeding, bruising, bulging, discoloration, warmth, pain or swelling at the graft site. [1]
How do I protect my dialysis graft arm?
Avoid sleeping on the graft arm, wearing tight clothing or jewelry on it, and lifting more than about 10 pounds while it heals. Ask staff not to take blood pressure or draw blood from that arm.
What happens if my dialysis graft clots?
A clot can stop blood from flowing through the graft. Your care team may remove the clot with a procedure, or replace the graft, so call right away if you can't feel the usual vibration.
Related Reading
Dialysis Fistula (AV Fistula): A Guide to Long-Term Hemodialysis Access explains how an AV fistula is made and cared for.
Hemodialysis: How It Works, Types, Risks, and What to Expect explains how hemodialysis cleans the blood and its main risks.
Chronic Kidney Disease: What It Is, Its 5 Stages, Causes, and How It's Treated covers the stages, causes and treatment of chronic kidney disease.
Kidney Transplant: Understanding the Procedure, Benefits, and Recovery explains how a kidney transplant works and what recovery is like.
References
Cleveland Clinic. Dialysis Graft: Purpose, Procedure, Risks & Results. Cleveland Clinic. Last updated March 5, 2026. https://my.clevelandclinic.org/health/treatments/dialysis-graft
Almasri J, Alsawas M, Mainou M, et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. Journal of Vascular Surgery. 2016;64(1):236-243. PMID: 27345510. https://doi.org/10.1016/j.jvs.2016.01.053
Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. Journal of the American Society of Nephrology. 2013;24(3):465-473. PMID: 23431075. https://doi.org/10.1681/ASN.2012070643
Yang C, Yang W, Xiao L, et al. Comparative outcomes of arteriovenous fistulas and grafts in haemodialysis: meta-analysis with subgroup analysis by fistula type and transposition status. BJS Open. 2026;10(2):zraf165. PMID: 41921109. https://doi.org/10.1093/bjsopen/zraf165
Disclaimer
This article is for general education and does not replace advice from your own doctor or dialysis care team. Always follow the instructions you are given for your specific situation, and seek medical help promptly if you notice any warning signs at your graft site.
Comments