Subsartorial mid-thigh graft for hemodialysis access in patients with exhausted arm veins

Abstract EN

To study the value of a mid-thigh graft as an alternative in the provision of long-term vascular access in patients requiring hemodialysis 11 patients (9 females, 2 males) aged 27-71 (mean 48 years) with unsuitable arm veins underwent surgery between February 2001 and January 2004 to create an arteriovenous fistula (AVF) between the superficial femoral artery (SFA) and superficial femoral vein (SFV).

There were no deaths due to the procedure, no limb losses, no technical failures and all fistulae matured satisfactorily.

Complications included two cases of thrombosis (surgically thrombec-tomised at 15 and 24 months post-operatively), one case of graft infection at three years post-operatively (treated by graft excision), and one graft failure at five years post-operatively (replaced with a second graft at the same site).

After three years 10 grafts were functional and being used for dialysis.

It was concluded that a mid-thigh graft is a suitable durable procedure in patients where creation of vascular access at the upper limbs is not feasible.

Adequate clinical and radiological surveillance is imperative.