A. Korzets et al., THE FEMORAL ARTERY-FEMORAL VEIN POLYTETRAFLUOROETHYLENE GRAFT - A 14-YEAR RETROSPECTIVE STUDY, Nephrology, dialysis, transplantation, 13(5), 1998, pp. 1215-1220
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.