Articles | Arteriovenous Graft (AVG) Placement: What You Need to Know

Introduction

For patients living with chronic kidney disease (CKD), especially those in end-stage renal failure, dialysis becomes a life-saving necessity. Hemodialysis, the most common form of dialysis, requires a reliable method for accessing the bloodstream. This is where vascular access comes into play. Without an efficient access point, hemodialysis can't remove waste products and excess fluid from the body effectively.

Among the options available, arteriovenous graft (AVG) placement stands out as a critical alternative for patients who aren’t candidates for the more commonly preferred arteriovenous (AV) fistula. AVGs are often the solution when veins are too small, scarred, or otherwise unsuitable for fistula creation.

As demand for dialysis grows globally—especially in aging populations and patients with diabetes or hypertension—AVG placement has become increasingly essential in vascular access surgery. Clinics around the world are advancing their techniques, offering safer and more efficient graft placements to improve long-term outcomes.

In South Korea, Charm Vascular Clinic is at the forefront of providing specialized, minimally invasive vascular procedures, including AVG placement, for patients who require reliable and sustainable dialysis access.

What Is an Arteriovenous Graft (AVG)?

An arteriovenous graft (AVG) is a synthetic tube that connects an artery to a vein, creating a passageway for blood flow suitable for hemodialysis. It serves as an artificial bridge when a natural AV fistula cannot be created due to inadequate blood vessels.

Unlike a fistula, which relies on directly connecting an artery and vein and requires weeks to mature, an AVG typically becomes usable for dialysis in a much shorter time—sometimes as little as 2 to 3 weeks. This makes it especially beneficial for patients who need quicker access for treatment.

The graft is usually made from biocompatible materials, such as polytetrafluoroethylene (PTFE), which minimizes the risk of rejection and clotting. It is surgically placed under the skin, commonly in the forearm, upper arm, or thigh, depending on patient anatomy and prior surgeries.

The AVG allows high blood flow rates, which are necessary for efficient dialysis. However, because it involves synthetic material, it can be more prone to complications such as infection or narrowing (stenosis), which makes expert monitoring and maintenance essential.

When Is an AVG Recommended Over an AV Fistula?

While AV fistulas are often the first choice for vascular access due to their lower risk of infection and longer lifespan, not every patient is a candidate. An AVG is typically recommended in the following situations:

The patient has small, scarred, or diseased veins that won’t support a natural fistula.
Previous AV fistula attempts have failed or thrombosed.
The patient requires quicker access than a fistula can provide.
There’s a need for temporary or intermediate-term access while waiting for a more permanent solution.

AVGs offer the advantage of a shorter maturation time, meaning they can be used for dialysis sooner. However, they generally have a higher rate of complications compared to AV fistulas, including clotting and infection.

At Charm Vascular Clinic, the decision between an AV fistula and AVG is made using advanced vascular imaging and thorough pre-operative assessments. The multidisciplinary team, led by Dr. Insoo Park, collaborates closely with nephrologists to ensure each patient receives the most suitable and effective type of dialysis access based on their individual vascular condition.

The AVG Placement Procedure: Step-by-Step

1. Pre-operative Evaluation

Before the procedure, patients undergo detailed assessments including vascular ultrasound mapping, blood tests, and medical imaging. This helps the surgeon determine the best location for the graft and assess vein and artery quality.

2. The Surgical Process

The procedure is performed under local or regional anesthesia with sedation to ensure patient comfort. A small incision is made to expose an artery and a nearby vein. The synthetic graft is then tunneled under the skin and sewn to both the artery and vein, forming a loop or straight configuration depending on anatomy.

3. Procedure Duration

The surgery typically takes 1 to 2 hours, and most patients can return home the same day. The site is bandaged, and mild soreness or swelling may be experienced in the following days.

4. Post-Operative Monitoring

After placement, patients are monitored for thrill (vibration) or bruit (whooshing sound) at the graft site to confirm good blood flow. At Charm Vascular Clinic, high-frequency Doppler ultrasound is used post-op to confirm patency and identify early signs of complications.

This procedure requires the skill of an experienced vascular surgeon to ensure proper placement and minimize complications. Charm Vascular Clinic uses minimally invasive techniques and advanced graft materials to promote faster healing and reduce risk, setting the standard for high-quality dialysis access in Korea.

Risks and Benefits of AVG Placement

Like all surgical procedures, arteriovenous graft (AVG) placement carries both benefits and potential risks. Understanding these can help patients make informed decisions alongside their care team.

Benefits of AVG Placement

Quick usability: Unlike AV fistulas, which can take weeks or months to mature, AVGs are often usable within 2 to 3 weeks, and in some cases even sooner.
Suitable for complex cases: Patients with small, scarred, or previously accessed veins often benefit from AVG when fistulas aren't an option.
Reliable flow for dialysis: AVGs allow for consistent high blood flow, crucial for effective hemodialysis.
Minimally invasive options: Modern techniques and imaging allow for precise graft placement with smaller incisions and faster recovery.

Risks to Be Aware Of

Infection: Since AVGs use synthetic material, there is a slightly higher risk of infection compared to native fistulas.
Thrombosis (clotting): Grafts can become blocked over time due to blood clots or narrowing at the connection points.
Stenosis: The graft or nearby veins may narrow, leading to reduced dialysis efficiency.
Repeated interventions: Some patients may need follow-up procedures, such as balloon angioplasty or revision surgery, to keep the graft functional.

At Charm Vascular Clinic, Dr. Insoo Park and his team proactively mitigate these risks by using biocompatible graft materials, employing image-guided placement techniques, and providing post-operative surveillance to detect and treat issues early.

Recovery Timeline and Post-Op Care

After an AVG placement, the recovery process is typically straightforward — but diligent care and monitoring are essential to avoid complications.

Immediate Post-Op Period

Most patients experience mild soreness or swelling at the graft site.
Pain is usually managed with oral analgesics, and patients can return home the same day or within 24 hours.
The graft site is covered with a sterile dressing, and patients are advised to keep it clean and dry.

1 to 2 Weeks Post-Op

Sutures or staples may be removed around this time.
Patients should monitor the site daily for signs of infection, such as redness, warmth, or discharge.
It's also important to feel for a "thrill" (vibration) and listen for a "bruit" (soft sound) at the graft site, indicating proper blood flow.

When Can Dialysis Begin?

Typically, an AVG can be used for dialysis 2 to 3 weeks after surgery, once healing is sufficient and blood flow is confirmed.
In certain cases, especially with early cannulation grafts, access may begin sooner — depending on clinical judgment.

Ongoing Follow-Up

Regular vascular access checks are crucial for long-term graft function.
At Charm Vascular Clinic, patients receive scheduled ultrasound surveillance and access to urgent evaluation if problems arise.
The clinic’s structured follow-up ensures high success rates and early detection of issues, keeping patients safely on dialysis without interruption.

Maintenance of an Arteriovenous Graft

Maintaining a healthy AVG is a shared responsibility between patients and the care team. Proper maintenance extends the lifespan of the graft and prevents potentially serious complications.

Daily Self-Checks

Patients are taught how to:

Feel for a vibration (thrill) at the graft site — a sign blood is flowing.
Listen for a sound (bruit) using a stethoscope.
Watch for signs of infection, swelling, or bleeding. If the thrill disappears or the bruit weakens, it may indicate a blockage or clot, and immediate medical attention is required.

Routine Surveillance

Vascular clinics use:

Ultrasound or fistulograms to assess blood flow and detect narrowing (stenosis).
Pressure monitoring during dialysis to flag abnormal access function.
Timely intervention, such as balloon angioplasty or stent placement, to keep the graft open.

Preventive Measures

Avoid heavy lifting or sleeping on the graft arm.
Do not allow blood pressure readings or blood draws from the graft arm.
Keep the graft site clean and avoid trauma or scratching.

At Charm Vascular Clinic, the team educates each patient on home care and provides a direct access line for urgent questions or concerns. This commitment to proactive care has made the clinic a trusted destination for vascular access maintenance.

Common Complications and How They’re Managed

While AVGs are reliable, certain complications can arise. Knowing what to watch for — and how they're managed — is key to keeping the graft functional and the patient safe.

1. Thrombosis (Clotting)

Clot formation is one of the most common issues with AVGs. It can happen suddenly and prevent dialysis. Treatments include:

Thrombectomy (removal of the clot)
Angioplasty to widen narrowed sections
Catheter-directed thrombolysis using medication to dissolve clots

2. Stenosis (Narrowing of Vessels)

Often caused by repeated needle punctures or biological reaction to the synthetic material, stenosis can lead to poor dialysis clearance.

Balloon angioplasty is the standard treatment, performed under imaging guidance.
In some cases, a stent may be placed to keep the vessel open.

3. Infection

AVG infections can be localized or systemic. Early symptoms include redness, swelling, fever, and tenderness.

Treatment ranges from antibiotics to graft removal in severe cases.
Sterile technique during dialysis and proper hygiene reduce infection risk.

4. Aneurysm or Pseudoaneurysm

These are rare but can occur due to repeated puncture in the same site.

Management includes surgical revision or graft repair.
Patients are taught to rotate needle sites to prevent this.

At Charm Vascular Clinic, complication management is swift and precise. The use of advanced vascular imaging, interventional radiology, and on-site operating facilities ensures patients receive timely interventions without the need for hospital admission.

Real-Life Case Example: A Patient’s Journey

To better understand how AVG placement can improve dialysis outcomes, let’s look at the case of Mr. Lee, a 67-year-old patient with advanced chronic kidney disease and a history of failed AV fistula attempts.

Mr. Lee had undergone two unsuccessful AV fistula procedures due to narrow and fragile veins, which left him dependent on a central venous catheter—a short-term solution with a high infection risk. Referred to Charm Vascular Clinic, he underwent a comprehensive vascular assessment, where the team determined that an AVG would be the most suitable option for long-term dialysis access.

Dr. Insoo Park performed the AVG placement using minimally invasive techniques, and Mr. Lee was discharged the same day. Within two weeks, his graft was fully functional, allowing him to transition off the catheter safely. He resumed dialysis with improved efficiency and experienced no complications during follow-up.

Mr. Lee now visits the clinic regularly for graft monitoring, and his dialysis sessions have been smooth and uninterrupted. His story reflects the clinic’s patient-centered approach—focused on restoring quality of life while minimizing complications.

Innovations in AVG Technology and Materials

The field of vascular access is constantly evolving, with technological innovations that enhance the performance and safety of arteriovenous grafts. These advances are helping patients live longer and more comfortably on dialysis.

1. Improved Graft Materials

Modern AVGs are now made with biocompatible, flexible materials that reduce clotting and inflammation. Some new grafts incorporate heparin bonding or antimicrobial coatings to lower the risk of thrombosis and infection.

2. Early Cannulation Grafts

These specially designed grafts can be used for dialysis within 24 to 72 hours after placement—ideal for patients who require urgent access but want to avoid a catheter. These are particularly useful in emergency dialysis scenarios.

3. Imaging-Guided Placement

The use of intraoperative Doppler ultrasound and fluoroscopy during graft placement allows for highly precise surgery. This improves placement accuracy, reduces operating time, and lowers the risk of post-op complications.

4. Drug-Coated Balloons and Stents

In cases of stenosis, drug-eluting devices are now being used during angioplasty procedures to reduce the recurrence of narrowing. These technologies prolong the lifespan of the AVG and reduce the need for repeat interventions.

At Charm Vascular Clinic, innovation is part of the standard of care. The clinic participates in vascular research and utilizes cutting-edge materials and methods to give patients access to the most effective and reliable treatments available.

Why Choose Charm Vascular Clinic for AVG Placement?

Choosing the right medical team for AVG placement can make all the difference in long-term dialysis success. Charm Vascular Clinic is a premier destination for patients seeking expertise, innovation, and compassionate care in vascular surgery.

World-Class Medical Expertise

Led by Dr. Insoo Park, a top graduate of the Catholic University School of Medicine, the clinic is known for its excellence in minimally invasive vascular treatments. With over 2,000 vascular surgeries performed annually, patients can trust they’re in experienced hands.

Personalized, Patient-First Approach

Every patient receives a thorough preoperative evaluation, including advanced vascular mapping. This ensures that the chosen access—whether AVG, fistula, or other—is tailored to the patient’s anatomy and health needs.

Minimally Invasive Techniques

Charm Vascular Clinic specializes in ultrasound-guided, image-assisted procedures that minimize trauma and accelerate recovery. Many patients return home the same day and start dialysis shortly after.

Ongoing Graft Maintenance and Support

The clinic provides long-term follow-up, including surveillance ultrasounds and emergency intervention services. This proactive care model helps reduce complications and maximize graft longevity.

Located in Seoul’s Gwanak-gu district, near Seoul National University Station, Charm Vascular Clinic is easily accessible to local and international patients alike, offering world-class vascular care in a convenient and welcoming environment.

Global Trends: AVG Placement Around the World

As the global burden of kidney disease continues to rise, so does the demand for effective and sustainable dialysis access. Arteriovenous grafts are becoming an increasingly common solution, particularly in regions with high rates of vascular disease or aging populations.

1. AVG vs. AV Fistula Preferences

In countries like the United States, AVG usage is common in patients who are not ideal candidates for fistulas—especially the elderly or those with diabetes. Guidelines by the National Kidney Foundation recommend AVGs when fistulas are not feasible.

In South Korea and Japan, AVG usage has also gained popularity due to technological advancements and the expertise available at specialized clinics like Charm Vascular Clinic.

2. Regional Factors and Practice Patterns

In Europe, there is a strong push for fistula-first policies, but AVGs remain an important secondary option.
In developing nations, limited access to vascular specialists can delay AVG availability, leading to prolonged catheter use—a risk factor for infection.

3. The Role of Medical Technology

New graft designs, better surgical tools, and improved post-op protocols are helping to increase the success rate of AVG placements globally. Early cannulation grafts are now used in over 20% of new graft placements in some countries.

4. Global Research and Collaboration

Charm Vascular Clinic is actively involved in international vascular conferences and publishes in peer-reviewed journals. By sharing data and insights, the clinic contributes to a global knowledge base that is helping refine AVG best practices worldwide.

Frequently Asked Questions About AVG

Q1: How long does an AVG last?
An AVG typically lasts 2 to 3 years with proper care, though some can function longer with regular maintenance and interventions.

Q2: Is AVG placement painful?
The procedure is performed under local or regional anesthesia, so patients feel minimal discomfort. Some soreness is normal post-op but usually resolves within days.

Q3: Can I travel or exercise after an AVG?
Yes, once healed, you can resume daily activities. Avoid heavy lifting or pressure on the graft arm. Always consult your care team before making lifestyle changes.

Q4: How is AVG different from a fistula or catheter?

Fistula: Natural, lower infection risk, longer maturation.
AVG: Synthetic, faster use, suitable for patients with weak veins.
Catheter: Temporary, higher infection risk.

Visual Aids for Patient Understanding

Visual learning helps patients better grasp the procedure and aftercare. Common visual aids include:

Diagrams showing how the AVG connects artery to vein.
Before/after images of graft sites during recovery.
Animations or videos that explain the surgical process.
Printed care instructions with pictures for home reference.

At Charm Vascular Clinic, patients receive clear visual materials during education sessions to help them feel confident and informed every step of the way.

Conclusion

For many patients, AVG placement offers a safe, effective solution for long-term dialysis access—especially when a fistula isn't an option. While complications can occur, they’re manageable with expert care and proactive monitoring.

At Charm Vascular Clinic, patients receive world-class treatment from a team committed to personalized, minimally invasive care. From pre-op planning to long-term graft maintenance, the clinic provides a seamless experience tailored to each patient’s needs.

If you or a loved one is exploring dialysis access options, schedule a consultation with Charm Vascular Clinic today—and take the next step toward reliable, life-sustaining care.