Outcome of prosthetic thigh vascular access graft in hemodialysis patients: a prospective six year study

ABSTRACT

Arteriovenous fistulae traditionally have been placed in the upper extremity. Experience with groin hemodialysis access has been discouraging because of high infection rates and associated limb amputation. The aim of this study was to determine infection rates, patency rates, and possible predictive factors for prosthetic thigh angioaccess outcomes in our hemodialysis patient population. A prospective study was performed for 53 patients who underwent placement of thigh vascular access graft at Sina Hospital, Tehran University of Medical Sciences, between Jan 2000 and July 2005. Demographics, complications, and subsequent treatment were recorded. Survival distributions were plotted using the Kaplan-Meier method for graft survival [primary patency]. Log rank tests were used to evaluate for statistical differences in survival distribution between different groups. The primary patency rates were, 78.4%, 61.2%, 56.2%, and 50% at 3, 6, 9 and 12 months, respectively. There were 15 [28.3%] access failures, related to infection in 2 cases [3.7%], thrombosis in 10 cases [18.9%] and bleeding in 3 case [5.7%].There was no limb ischemia.No significant differences in infection rate or graft patency rates were found by patients' age and gender. A PTFE vascular access in the thigh is not associated with higher morbidity compared with the upper extremity, and should be considered as a promising alternative when upper extremity arteriovenous fistulas cannot be constructed .The incidence of infection and thrombosis in our series is comparable with rates reported in the literature for lower extremity polytetrafluoroethylene angioaccess grafts