title: The Thomas shunt revisited.
abstract: During a 10-year period, 57 external Thomas femoral shunts (TS) were placed in 43 patients for chronic hemodialysis access. Median shunt survival was 28 months (range, 0.5 to 132). Sixty-three percent (36/57) of shunts are presently functional or functioned until the time of patient death from unrelated cause or removal after renal transplantation. The remaining 37% (21/57) failed after a mean duration of 18 months (range, 2 to 40). Causes of failure were thrombosis (57%), refractory infection (24%), and failure during surgical revision (19%). There were no shunt-related deaths. Race, sex, the presence of diabetes mellitus or hypertension, and prior surgical revision of access did not adversely affect shunt survival. These results support the TS as a viable means of chronic vascular access for hemodialysis patients who cannot receive further upper arm accesses.
authors.affiliation: Department of Internal Medicine/Nephrology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1053.
authors.forename: B I
authors.initials: BI
authors.lastname: Freedman
authors.forename: R L
authors.initials: RL
authors.lastname: Anderson
authors.forename: A B
authors.initials: AB
authors.lastname: Tuttle
authors.forename: V J
authors.initials: VJ
authors.lastname: Canzanello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005268:Femoral Vein / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis