Document Detail


Prosthetic lower extremity hemodialysis access grafts have satisfactory patency despite a high incidence of infection.
MedLine Citation:
PMID:  20732779     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: 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.
Authors:
Irma L Geenen; Lydia Nyilas; Michael S Stephen; Virginia Makeham; Geoffrey H White; Deborah Jean Verran
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Publication Detail:
Type:  Journal Article     Date:  2010-08-21
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-04-06     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1546-50     Citation Subset:  IM    
Copyright Information:
Crown Copyright © 2010. Published by Mosby, Inc. All rights reserved.
Affiliation:
Transplantation and Vascular Surgical Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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MeSH Terms
Descriptor/Qualifier:
Arteriovenous Shunt, Surgical* / adverse effects
Blood Vessel Prosthesis* / adverse effects
Female
Femoral Artery
Femoral Vein
Humans
Kaplan-Meier Estimate
Lower Extremity
Male
Middle Aged
Polytetrafluoroethylene
Prosthesis-Related Infections / etiology*
Renal Dialysis*
Risk Factors
Thrombosis / etiology
Vascular Patency*
Chemical
Reg. No./Substance:
9002-84-0/Polytetrafluoroethylene

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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