Abstract
Background Patients who are no longer candidates for upper-extremity haemodialysis arteriovenous (AV) grafts or fistulae present a difficult problem. The vascular surgeons at Mansoura University Hospital used a loop AV graft in the thigh in 30 patients with end-stage renal failure during the period from January 2008 to January 2011. Patients and methods Patients in this retrospective study underwent femoral AV loop graft placement when there was no alternative access to the upper extremity. The primary and secondary patency rates were determined using the Kaplan-Meier method. Results The 30 patients who underwent a femoral AV loop polytetrafluoroethylene (PTFE) graft in the upper thigh had a mean follow-up of 18 months (range 4-36 months). Early access failure due to thrombosis was reported in two patients in the superficial femoral artery ( n = 26) inflow group and due to infection in one patient in the common femoral artery group ( n = 4). The cumulative graft survival was calculated using the Kaplan-Meier analysis method and it was 93% in the sixth month, 87% at the end of the first year, and 71% after 24 months to reach 30% at the end of our study. There were no cases of limb amputation (0%) in our study, nor any incidences of operative deaths in our series. Although strict aseptic procedures were adopted, the incidence of infection among the studied patients was 16.7% and it was responsible for final graft failure at the end of the study. Conclusion Finally, we found that the thigh PTFE graft had the advantage of long length, which enables different cannulation sites, easy use, and high flow, which reduces the thrombosis rate. It was a good alternative to exhausted upper-extremity access. Choice of the lower-extremity femoral AV graft should take into account the patient's comorbidities and peripheral vascular disease. Further research with randomized studies is required to consolidate our results.
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