Lower Extremity Permanent Dialysis Vascular Access

Abstract

Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Frequently encountered difficulties in clinical practice include (1) a high incidence of central venous catheter-related central vein stenosis and (2) limited options for creating a functioning upper extremity permanent arteriovenous access. Lack of surgical skills, fear of complications, and limited involvement of the treating nephrologists in the decision-making process are some of the reasons why lower extremity permanent dialysis access remains an infrequently used option. Similar to upper extremity vascular access options, lower extremity arteriovenous fistula remains a preferred access over arteriovenous synthetic graft. The use of femoral tunneled catheter as a long-term access should be avoided as far as possible, especially with the availability of newer graft-catheter hybrid devices. Our review provides a summary of clinical evidence published in surgical, radiology, and nephrology literature highlighting the pros and cons of different types of lower extremity permanent dialysis access.

Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients

“…Using the propensity score matching, we found 111 days survival difference between jugular catheters (771 days) and femoral ones (660 days; p < 0.03; Table 5). Our finding that 66% of the femoral catheters were functional after 3 years is the best survival reported so far in the literature and supports the use of this location for the long-term management of patients on chronic hemodialysis [11][12][13][14][15][16][17][18]. Catheter location did not affect mortality.…”

“…The OS of DOI: 10.1159/000494206 right jugular was 111 days more than the femoral catheters and this difference was statistically significant (p < 0.03). What is of interest and according to our knowledge, the survival of our femoral catheters is the longest reported so far in the literature [11][12][13][14][15][16][17][18]. Age, sex, diabetes, and mortality were similar in both groups, while time on hemodialysis and Qb was different between these 2 populations (Table 5).…”

“…We modified Table 7 from reference [18] that summarizes 7 papers published [11][12][13][14][15][16][17], and the results obtained in our Femoral catheter (c) (n = 144) survival was significantly different from (a) (n = 766) (b) (n = 622) p < 0.002. study. The survival time in our cases was significantly longer as shown in Table 7.…”

“…When prolonged use of the upper extremities leads to occlusion of the central veins, the femoral route is the choice. The literature on complications, survival time and outcomes of tunneled femoral catheters, compared to that of jugular catheters, is limited and derived mainly from small cohorts of patients [11][12][13][14][15][16][17][18].…”

Tertiary Vascular Accesses: Which One do You Control?

“…Surgical technique, transposition of the femoral vein (tVF) for AVF -LL, remains the best compared to other techniques, such as the use of the saphenous vein or arteriovenous graft [6].…”