Prosthetic lower extremity hemodialysis access grafts have satisfactory patency despite a high incidence of infection.
BACKGROUND
Prosthetic arteriovenous grafts (AVGs) in the lower extremity represent a useful alternative for hemodialysis vascular access when all upper limb access sites have been used or in some patients when freedom of both hands is necessary during dialysis. Reported complications include an increased risk of infection and limb ischemia. This study evaluated our experience with the patency outcomes and complication rates of polytetrafluoroethylene (PTFE) AVGs placed in the thigh.


METHODS
A retrospective outcomes analysis was performed of all femoral AVGs inserted between January 1992 and July 2007. Data were obtained by review of medical records for patient demographics, comorbidities, and AVG-related outcomes. Patency, complication rates, and risk factors for infection were determined.


RESULTS
A total of 153 prosthetic AVGs were placed in 127 patients (63 men). Mean patient age was 52.7 ± 16.3 years. Median follow-up was 25 months (range, 1-169 months). The most common underlying renal disease was glomerulonephritis in 27 (21%). Hypertension and coronary artery disease were common comorbidities, respectively, in 49 (39%) and 23 patients (18%). The primary and secondary AVG patency rates at 12 months were 53.9% and 75.3%, respectively, and 2- and 5-year patency rates were, respectively, 39.6% and 19.3% (primary) and 63.8% and 50.6% (secondary). The mean AVG survival for all cases was 31.6 months (range, 0-149 months). Surgical thrombectomy was required in 82 (54%), and 22 AVGs (14%) required surgical revision for stenosis. Infection occurred in 41 AVGs (27%), and limb ischemia occurred in 2 (1.3%). Statistical analysis did not reveal a significant risk factor for infection.


CONCLUSIONS
Femoral AVGs are a suitable alternative to upper limb vascular access, with acceptable primary and secondary patency rates. Infection occurred in approximately one-quarter of cases, whereas steal was uncommon.
Geenen
Irma L
IL
Transplantation and Vascular Surgical Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Nyilas
Lydia
L
Stephen
Michael S
MS
Makeham
Virginia
V
White
Geoffrey H
GH
Verran
Deborah Jean
DJ
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery; D005268:Femoral Vein; D006801:Humans; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D016459:Prosthesis-Related Infections / Q000209:etiology*; D006435:Renal Dialysis; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D014654:Vascular Patency
D011138:Polytetrafluoroethylene