What is the preferred vascular access for long-term hemodialysis?

• A. Arteriovenous fistula
• B. Central venous catheter
• C. Arteriovenous graft
• D. Peritoneal dialysis catheter

Answer: (A)

For long-term hemodialysis, the preferred vascular access is a native arteriovenous fistula. Creating a fistula by directly connecting a patient’s artery to a vein yields a durable, long-lasting access that can be cannulated repeatedly over years. It has the lowest risk of infection and thrombosis among the options, which means fewer hospitalizations and fewer interventions. The trade-off is that it takes time to mature (weeks to months) before it can be used, and its success depends on good vein quality and arterial inflow.

Compared with a central venous catheter, which can be placed quickly but carries a high infection risk and other complications, the catheter is usually a temporary bridge rather than a long-term solution. An arteriovenous graft uses synthetic material and tends to mature faster than a fistula but has higher rates of infection and stenosis than a native fistula. A peritoneal dialysis catheter is designed for peritoneal dialysis, not hemodialysis, so it isn’t the access used for long-term HD.