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Arteriovenous Grafts in the Thigh: An Excellent Hemodialysis Vascular Access When Arm Vasculature Is Exhausted
Author(s) -
Ponikvar Rafael
Publication year - 2013
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12089
Subject(s) - medicine , hemodialysis access , hemodialysis , thigh , vascular access , surgery
The aim of our retrospective analysis with prospective collected data was to evaluate the patency of thigh expanded polytetrafluoroethylene ( ePTFE) arteriovenous ( AV) grafts, which were placed in chronic hemodialysis patients by the same interventional nephrologist skilled in hemodialysis access vascular surgery. From F ebruary 1991 until M arch 2013, 35 thigh ePTFE grafts were placed in 31 chronic hemodialysis patients. Twenty (57%) were women, mean age 58.7 ± 14.5, dialysis vintage 11.9 ± 7.3 years, mean number of previous vascular accesses 4.4 ± 1.9. Two of the 35 (5.7%) grafts were lost to follow‐up, immediate failure occurred in 1/35 (2.8%) grafts, and thrombosis appeared within 30 days in 2/35 (5.7%) grafts. Four of the 31 patients died with functioning grafts, while in 9/31 patients the grafts are still patent. In the remaining 17 AV grafts that thrombosed, no surgical intervention was performed in 8/17, while 18 thrombectomies (two per graft) were performed in 9/17 to maintain graft patency. The immediate success rate was 97.1%. Primary patency was from 0–3251 days, on average 906 ± 898, median 472, cumulative patency ( N = 33) was from 0–3251 days, on average 1174 ± 954, median 966. Cumulative patency of the grafts that were patent for more than 30 days ( N = 30) was from 153–3251 days, on average 1298 ± 921, median 1207. The ePTFE graft survival after the 1st year was 78%, after the 2nd year 74%, after the 3rd year 66%, after the 4th year 56%, after the 5th year 52%, and after the 9th year 13 %. The longest patency was 3251 days without any intervention. Steal syndrome occurred in two patients after 2522 and 275 days after fistula placement.