A study published recently in the Journal of Vascular Access has indicated that the use of arteriovenous thigh graft access is viable as an alternative for patients who have exhausted all other access options.
Denise Kim (Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada) and colleagues performed a retrospective study of all thigh arteriovenous access grafts placed between 1995 and 2015. The clinical, demographic patient information and patency of each thigh graft was determined from the time of surgical creation placement until abandonment, transfer to other modality, or centre or end of study, and the reason for access failure documented.
The authors found that, in total, 44 patients received 49 thigh arteriovenous accesses. The average age was 60 years (13–79 years); half (53%) of the patients (n=24) were female and 61% of the patients (n=30) of arteriovenous accesses were left-sided. The cumulative proportion surviving (primary patency rates) at 12, 24, and 28 months were 43% (standard error=9%), 33% (standard error=9%), and 13% (standard error=9%), respectively. The cumulative proportion of surviving grafts at 12, 24, and 48 months were 61% (standard error=8%), 58% (standard error=9%), and 31% (standard error=13%), respectively.
In total, 37 revisions were performed in 22 patients to maintain patency or eradicate infection. Infection occurred in 20 patients (39%) of thigh grafts requiring 16 patients (80% of those affected) to be removed; 14 patients had grafts (33.3%) that served as the lone haemodialysis arteriovenous access during the patients’ lifetime on dialysis.
Kim et al conclude that while arteriovenous thigh graft access is used infrequently, their study shows that they have an acceptable patency. They noted that some accesses require revisions and that they observed a high infection rate in their cohort of patients with arteriovenous thigh graft access. “Despite this, an acceptable proportion of leg grafts provide durable access for the dialysis lifetime of the patient,” Kim et al maintain.