A hemodialysis access is a fistula that directly connects an artery to a vein. The vein is extended over time to allow for dialysis puncture. Autologous fistulas are the gold standard for hemodialysis.
Advantages
Permanent
Located subcutaneously
Longer duration of use
Provides greater blood flow for hemodialysis
Reduces the incidence of infection and other complications
Reduces hospitalizations
Better survival (can reduce risk of death compared to catheters)
Disadvantages
Not easy to mature
Not available for all patients
Usually not available for 6-8 weeks
Artificial vascular arteriovenous fistula
Usually a tube made of malleable material with which an arterial vein is connected for puncture. Artificial vascular arteriovenous fistulas are a second choice in hemodialysis access.
Advantages
Permanent
Located subcutaneously
Can be used after 2 weeks in some cases
Provides an option for patients with poor venous conditions
Disadvantages
May increase the chance of hospitalization
Increases risk of blood clots
Increased risk of infection
Increased risk of complications and surgical maintenance
Shorter duration of use than autologous fistula
Catheter
A catheter is a tube inserted into a neck or chest vein through which vascular access is provided for hemodialysis, with the tip placed in the heart. It is usually a temporary hemodialysis access. It is the third option for access in hemodialysis, but for some patients it is the only option and can only be used as a permanent access.
Advantages
Can be used immediately after placement
Disadvantages
Higher rate of infection, it can be very serious or even fatal
Increased chance of hospitalization
Does not last as long
May require longer treatment time
Long-term use may lead to inadequate dialysis
Inconvenient showers and need for special dressings
High incidence of thrombosis, requiring frequent repair
Risk of damaging vital veins