THE FEMORAL ARTERY-FEMORAL VEIN POLYTETRAFLUOROETHYLENE GRAFT - A 14-YEAR RETROSPECTIVE STUDY

Background. The use of the femoral vessels for permanent haemodialysis access has been neglected during the last two decades. Since 1981 fem oral artery-vein loop polytetrafluoroethylene grafts have been constru cted in our chronic haemodialysis patients. This study examines result s obtained in patients with this particular graft over the last 14 yea rs. Methods. This clinical study is retrospective in nature. Overall 3 5 patients, with 37 femoral grafts, are included. Inclusion and exclus ion criteria for this type of graft are given and the surgical procedu re detailed. Results. Seven patients had femoral grafts used as primar y dialysis access. Twenty-eight patients had femoral grafts used after multiple access failures. There was no perioperative mortality. Immed iate thrombotic non-function of the graft occurred in three patients. In the long term no patient death was related to the femoral grafts. T wenty-seven (73%) grafts had no long-term complications, The leading c ause for graft 'loss' was patient death; in the first year 10 grafts w ere lost, eight because of patient death. All eight patients died with functioning grafts. Median graft survival was 21 months in all patien ts and 28 months in non-diabetic patients. Twenty-seven (73%) grafts w ere patent at the end of the first year, 33% of grafts were still pate nt after 5 years. Worsening claudication occurred in four patients; on e diabetic required foot amputation. Four patients had late graft thro mbosis; only two patients had bacteraemia originating from the femoral graft. Urea reduction ratio greater than 60% was measured in 87.5% of patients. Conclusion. The femoral artery-vein graft is a good primary and secondary haemodialysis access. Both infection and thrombosis rat es are law and graft survival is comparable, if not superior to, that of upper-limb grafts. The graft is easy to cannulate, can be used earl y, is easily protected, and is cosmetically acceptable.