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2006 by the Societe Internationale de Chirurgie World J Surg (2006) 30: 171175Published Online: 21 January 2006 DOI: 10.1007/s00268-005-0062-5Single Center Review of Femoral Arteriovenous
Grafts for HemodialysisMichael J. Englesbe, MD, Wajd N. Al-Holou, Alice T. Moyer, Jessica Robbins, MD,Shawn J. Pelletier, MD, John Magee, MD, Randall S. Sung, MD, Darrell Campbell, MD,Jeffery D. Punch, MDDepartment of Surgery, Section of Transplantation, University of Michigan Health System, 2926 Taubman Center,1500 E Medical Center Drive, Ann Arbor, Michigan, 48109-0331, USAAbstractIntroduction: It is unclear how to manage high risk hemodialysis patients who present with anindwelling catheter. The National Kidney Foundation Practice Guidelines urge prompt removal ofthe catheter, but the guidelines do not specifically address the problem of patients whose onlyoption is a femoral arteriovenous (AV) graft.Methods: This study was a retrospective review of all patients who underwent femoral AV graftplacement for hemodialysis access between January 1, 1996 and January 1, 2003 at the University of Michigan Health System (UMHS). Graft patency is reported according to the standardsdeveloped by the Society of Vascular Surgery and the American Association of Vascular Surgeons.Results: Thirty patients were identified who had undergone femoral AV graft placement. The meanfollow-up was 23 months (range 175 months). The patients had had significant medical comorbidities and multiple previous access operations (mean 3; interquartile range 15). The 1-yearsecondary graft patency rate was 41%, the 2-year rate was 26%, and the 3-year rate was 21%.Infection was the cause of final graft loss in eight patients (50% of the grafts losses, 27% of thetotal grafts placed.) Among those who died (n = 14), the mean time from femoral graft placementto death was 31.2 27.5 months. The patient survival was quite low: at 1 year 81%, at 2 years68%, and at 3 years 54%.Conclusions: These complex patients who have exhausted their upper extremity hemodialysisoptions do poorly following femoral AV graft placement. Consideration should be given to longterm catheter-based access in some of these patients.Patients who are no longer candidates for upper
extremity hemodialysis arteriovenous (AV) grafts orfistulas present a difficult problem. These patients usuallyhave had multiple previous access surgeries, have beenin renal failure for extended periods of time, and have
multiple, severe medical co-morbidities. In our experience, these patients rarely have peritoneal dialysis ortransplantation as an option. Surgeons generally agreethat upper extremity...