Straight lateral thigh femoropopliteal-femoral arteriovenous graft an alternative vascular access for patients with exhausted upper limbs dialysis access

Abstract

Introduction: The durability of hemodialysis vascular access remains a troublesome issue for the patients as well as vascular surgeons that requires frequent reinterventions to maintain the access function. Aim: This study aimed to evaluate straight thigh polytetrafluethylene (PTFE) arteriovenous graft (AVG) in patients with exhausted upper extremities dialysis access. Method: Our study was a retrospective analysis of prospectively collected data of 30 patients were operated upon for straight pattern lateral thigh PTFE AVG between 2016 and 2018. The primary outcome was efficacy and patency of AVG, and secondary outcome was procedure safety, including infection, thrombosis, ligation, lower limb functional status, and mortality. Results: A 30 patients with 30 Lower Limb AVG with maximum 30-month follow-up period. The mean age was 48 years. Males were ( n = 15/30). Thrombophilia patients were ( n = 7/30). Primary patency at 6 months was 100%. It declined to 93% at 12 months, 73% at 18 months, 47% at 24 months, and 40% at 30 months. The secondary patency was 97% at 18 months, 83% at 24 months, and 73% at 30 months. More than half of the patients showed complications ( n = 18/30), the most frequent was thrombosis ( n = 16/18). A secondary procedure was needed for 17 patients, the most frequent was thrombectomy ( n = 11/17), adjunctive culprit lesion repair was the key for regaining graft patency. Graft removal was necessary in six patients due to infection ( n = 4) and ruptured graft aneurysm ( n = 2). Conclusion: Lateral straight thigh PTFE AVG is a reliable and durable alternative modality with adequate dialysis efficacy in patients with exhausted upper extremities dialysis accesses. Secondary procedures due to complications were frequent but no significant major bleeding as regard patients with ruptured graft were non-significant and no distal threatening ischemia or related deaths were observed.