Nephrology Dialysis Transplantation, Vol 13, Issue 5 1215-1220, Copyright © 1998 by Oxford University Press
A Korzets, Y Ori, S Baytner, D Zein, A Chagnac, T Weinstein, M Harman, M Agmon and U Gafter
Background: The use of the femoral vessels for
permanent haemodialysis access has been neglected during the last two
decades. Since 1981 femoral artery-vein loop polytetrafluoroethylene grafts
have been constructed in our chronic haemodialysis patients. This study
examines results obtained in patients with this particular graft over the
last 14 years. Methods: This clinical study is
retrospective in nature. Overall 35 patients, with 37 femoral grafts, are
included. Inclusion and exclusion criteria for this type of graft are given
and the surgical procedure detailed. Results: Seven
patients had femoral grafts used as primary dialysis access. Twenty-eight
patients had femoral grafts used after multiple access failures. There was
no perioperative mortality. Immediate thrombotic non-function of the graft
occurred in three patients. In the long term no patient death was related
to the femoral grafts. Twenty-seven (73%) grafts had no long-term
complications. The leading cause for graft 'loss' was patient death; in the
first year 10 grafts were lost, eight because of patient death. All eight
patients died with functioning grafts. Median graft survival was 21 months
in all patients and 28 months in non-diabetic patients. Twenty-seven (73%)
grafts were patent at the end of the first year, 33% of grafts were still
patent after 5 years. Worsening claudication occurred in four patients; one
diabetic required foot amputation. Four patients had late graft thrombosis;
only two patients had bacteraemia originating from the femoral graft. Urea
reduction ratio greater than 60% was measured in 87.5% of patients.
Conclusion: The femoral artery-vein graft is a good
primary and secondary haemodialysis access. Both infection and thrombosis
rates are low and graft survival is comparable, if not superior to, that of
upper-limb grafts. The graft is easy to cannulate, can be used early, is
easily protected, and is cosmetically acceptable.
ORIGINAL ARTICLES
The femoral artery-femoral vein polytetrafluorethylene graft: a 14-year retrospective study
The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nephrology and Vascular Surgery Unit, Rabin Medical Center-Golda Campus, 7 Keren Kayemet St, Petah Tikva 49372, Israel; Corresponding author
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