A vascular access should be prepared months or years before you start dialysis. The early preparation of the vascular access will allow easier and more efficient removal and replacement of your blood with fewer complications.

The three basic kinds of vascular access for hemodialysis are an arteriovenous (AV) fistula, an AV graft, and a venous catheter. A fistula is an opening or connection between any two parts of the body that are usually separate—for example, a hole in the tissue that normally separates the bladder from the bowel. While most kinds of fistula are a problem, an AV fistula is useful because it causes the vein to grow larger and stronger for easy access to the blood system. The AV fistula is considered the best long-term vascular access for hemodialysis because it provides adequate blood flow, lasts a long time, and has a lower complication rate than other types of access. If an AV fistula cannot be created, an AV graft or venous catheter may be needed.