Safety and efficacy of femoral-based hemodialysis access grafts

Tashjian, David B.; Lipkowitz, George S.; Madden, Robert L.; Kaufman, Jeffrey L.; Rhee, Sang Won; Berman, Joel; Norris, Marc A.; McCall, Jane

doi:10.1067/mva.2002.121750

Cited by 62 publications

(65 citation statements)

References 10 publications

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“…The SCV route is generally avoided because the rate of central vein stenosis is high, precluding the use of the entire arm for access (10). The FV has been explored as a route of long-term access placement (grafts or catheters) by a few researchers (11,12) The current weight of evidence supports the use of shared governance in making this decision (13,14). Thus, it is important to establish evidence-based guidelines and safe techniques for placement of a FV DC.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Femoral Dialysis Access Placement

Prabhu¹,

Juneja²,

Gopal³

et al. 2010

Clinical Journal of the American Society of Nephrology

116

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Background and objectives: Insertion of dialysis catheters (DCs) is a prerequisite for successful initiation of hemodialysis. We attempted to determine if ultrasonography-guided (USG) insertion was superior and safer than the anatomical landmarkguided technique (ALT) for the femoral vein (FV).Design, setting, participants, & measurements: This was a randomized prospective study on 110 patients requiring FV DCs in a tertiary care hospital. Patients were randomized into two groups: USG and ALT. Data were collected on demography, operator experience, and side of insertion. The USG group had their catheters inserted under USG guidance, whereas the ALT group had their DC inserted by ALT. Outcome measures included successful insertion of DC, number of attempts, and complications.Results: Both groups were comparable regarding age and gender of patients, operator experience, and the side of catheterization. The overall success rate was 89.1%, with 80% using ALT and 98.2% under USG guidance (P ‫؍‬ 0.002). First attempt success rate was 54.5% in the ALT group as compared with 85.5% in the USG group (P ‫؍‬ 0.000). The complication rate was 18.2% in the ALT group and 5.5% in the USG group (P ‫؍‬ 0.039). The odds ratio (OR) for complications with two or more attempts was 10.73 with a relative risk (RR) of 3.2. The OR for successful insertion using USG was 13.5 (95% CI: 1.7 to 108.7).Conclusions: USG significantly improves success rate, reduces number of attempts, and decreases the incidence of complications related to FV DC insertion.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Femoral Dialysis Access Placement

Prabhu¹,

Juneja²,

Gopal³

et al. 2010

Clinical Journal of the American Society of Nephrology

116

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“…All grafts are prone to recurrent stenosis and thrombosis, which can lead to permanent access failure (2), but there are few publications on the outcomes and complication of thigh grafts. Most published studies reported the outcomes of relatively few thigh grafts, with inconsistent definitions of graft outcomes (3)(4)(5)(6)(7)(8)(9)(10)(11). Three larger series (.100 thigh grafts) (12)(13)(14) provided information about graft outcomes using standardized definitions (15) but did not comprehensively analyze clinical factors or comorbid conditions that are associated with thigh graft outcomes.…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcomes of Arteriovenous Thigh Grafts in Hemodialysis Patients

Ong

Barker-Finkel

Allon

2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objective Arteriovenous thigh grafts are a potential vascular access option in hemodialysis patients who have exhausted all upper-limb sites. This study compared the outcomes of thigh grafts with outcomes obtained with dialysis catheters.Design, setting, participants, & measurements A prospective vascular access database was queried to identify 209 thigh grafts placed from January 1, 2003, to June 30, 2011. The following were calculated: secondary graft survival (from graft creation to permanent failure), assisted primary graft survival (from graft creation to first thrombosis), and infection-free graft survival (from graft creation to first graft infection). Graft outcomes were compared with those observed with 472 tunneled internal jugular dialysis catheters.Results The median duration of patient follow-up was 340 days for grafts and 91 days for catheters. The surgical technical failure rate of thigh grafts was 8.1% and was higher in patients with vascular disease (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.07-8.04; P=0.03). Secondary and assisted primary graft survival rates at 1, 2, and 5 years were 62%, 54%, and 38% and 38%, 27%, and 17%, respectively. Infection-free graft survival rates at 1, 2, and 5 years were 79%, 73%, and 61%. Secondary survival was much worse for dialysis catheters than thigh grafts (HR, 4.44; 95% CI,; P,0.001). Likewise, infection-free survival was far worse for catheters than for thigh grafts (HR, 3.77; 95% CI, 2.80-4.82; P,0.001).Conclusions Thigh grafts are a viable vascular option in patients who have exhausted upper-extremity options. Outcomes with thigh grafts are superior to those obtained with dialysis catheters.

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“…Given the frequent infectious and thrombotic complications of dialysis catheters (6), a thigh graft would seem to be the better option. However, the long-term outcomes of thigh grafts among hemodialysis patients has been reported only in retrospective series (7)(8)(9)(10)(11)(12), only two of which provided a comparison with a concurrent group of upper extremity grafts (8,11).…”

mentioning

confidence: 99%

Comparison of Arteriovenous Grafts in the Thigh and Upper Extremities in Hemodialysis Patients

Miller

Robbin²,

Barker³

et al. 2003

Journal of the American Society of Nephrology

113

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ABSTRACT. Placement of a thigh graft is an option in hemodialysis patients who have exhausted all upper extremity sites for permanent vascular access. The outcome of thigh grafts has been reported only in retrospective studies. The outcomes of 409 grafts placed at a single institution during a 3.5-yr period were evaluated prospectively, including 63 thigh grafts (15% of the total). Information was recorded on surgical complications, dates of radiologic and surgical interventions, and date of graft failure. The technical failure rate was approximately twice as high for thigh grafts, as compared with upper extremity grafts (12.7 versus 5.8%; P = 0.046). Intervention-free survival was similar for thigh and upper extremity grafts (median, 3.9 versus 3.5 mo; P = 0.55). Thrombosis-free survival was also comparable for thigh and upper extremity grafts (median, 5.7 versus 5.5 mo; P = 0.94). Cumulative survival (time to permanent failure) was similar for thigh and upper extremity grafts (median, 14.8 versus 20.8 mo; P = 0.62). When technical failures were excluded, the median cumulative survival was 27.6 mo for thigh grafts and 22.5 mo for upper extremity grafts (P = 0.72). The frequency of angioplasty (0.28 versus 0.57 per year), thrombectomy (1.58 versus 0.94 per year), surgical revision (0.28 versus 0.18 per year), and total intervention rate (2.15 versus 1.70 per year) was similar between thigh and upper extremity grafts. Access loss as a result of infection tended to be higher for thigh grafts than for upper extremity grafts (11.1 versus 5.2%; P = 0.07). In conclusion, placement of thigh grafts should be considered a viable option among hemodialysis patients who have exhausted all options for a permanent vascular access in both upper extremities. E-mail mdallon@uab.edu

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Safety and efficacy of femoral-based hemodialysis access grafts

Cited by 62 publications

References 10 publications

Ultrasound-Guided Femoral Dialysis Access Placement

Ultrasound-Guided Femoral Dialysis Access Placement

Long-term Outcomes of Arteriovenous Thigh Grafts in Hemodialysis Patients

Comparison of Arteriovenous Grafts in the Thigh and Upper Extremities in Hemodialysis Patients

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