Lower extremity vascular access for haemodialysis

Abstract EN

Objective : The lower extremities are increasingly used as an access site in end-stage renal disease patients.

This study describes our experience with constructing arteriovenous fistulae in the lower extremities.

Methods : This is a retrospective analysis of 19 patients who had arteriovenous fistulae construction at the lower extremities.

From January 2005 till January 2007, 19 patients (14 males, 5 females) aged 14-67 with unsuitable arm veins, underwent surgery to create arteriovenous fistula at the lower extremities.

Different techniques were used : groin loop fistula using saphenous vein or graft, mid-thigh graft, saphenous vein transposition and femoro-distal superficial femoral vein or femoro-saphenous graft.

Results : One patients developed graft infection in the groin and died eight weeks after surgery due to sepsis (5% mortality).

One patient developed steal symptoms requiring closure of the fistula.

In 17 patients maturation occurred and the fistulae were used for regular hemodialysis (90% primary patency).

Four cases of graft thrombosis occurred during follow up.

Surgical thrombectomy established adequate function in three patients.

Mid-thigh graft infection occurred in one patient three years after surgery and was treated by removal of the graft.

At two years follow up, 15 fistulae were functional and being used for dialysis (79% secondary patency ).

Conclusion : Vascular access at the lower extremities is a suitable durable procedure in patients where creation of vascular access at the upper limbs is not feasible.

Different techniques are available to create this access at the lower extremities.