When might someone need an AV graft instead of a fistula?

An AV graft is often utilized when an AV fistula fails to mature, which can happen due to various anatomical or physiological factors. A fistula requires the connection of an artery and a vein, allowing blood to flow from the artery into the vein, effectively enlarging it for easier access during dialysis. However, not all fistulas develop adequately; some may not provide sufficient blood flow or may take too long to mature.

In such cases where a fistula does not mature, an AV graft serves as an alternative. A graft uses a synthetic material to create a connection between the artery and vein, providing immediate access for dialysis once healed. This option becomes critical for patients requiring hemodialysis on a regular basis when timely vascular access is necessary.

Considering the other choices, high blood pressure typically does not dictate the choice between a fistula and a graft; both procedures can be performed in patients with hypertension. Chemotherapy may affect a patient’s overall health but does not directly relate to the choice of vascular access method. Renal failure certainly necessitates a method of dialysis, but the decision between a fistula and a graft primarily arises from the functional state of the patient's vessels rather than the presence of renal failure itself. Therefore, when an AV fistula