For all problems with dialysis accesses an important issue is the patient's need for dialysis. Inserting a temporary catheter in the neck or groin should be weighed against the possibility of a successful operation. A basic rule is that a revised dialysis access should be allowed at least a couple of days to heal after the procedure to avoid bleeding complications. Dialysis requires heparinization, which in combination with uremic patients' tendency for coagulopathy increases the risk for bleeding. During dialysis clots in the suture line are dissolved and bleeding is likely. Such bleeding is often difficult to treat. Moreover, interposed vein grafts have thin walls and are easy to damage during puncture. Vein grafts needs at least 10-14 days to be arterialized, and PTFE grafts should be incorporated in surrounding tissue to minimize the risk for bleeding. Accordingly, if the need for dialysis is urgent and the risk of surgical bleeding after revision is considered small, dialysis can be performed the first postoperative day providing that the puncture can be made in an old part of the access and that the heparin dose during dialysis is adjusted.
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