Comparison of Arteriovenous Grafts in the Thigh and Upper Extremities in Hemodialysis Patients

Miller, Christopher D.; Robbin, Michelle L.; Barker, Jill; Allon, Michael

doi:10.1097/01.asn.0000090746.88608.94

Cited by 95 publications

(121 citation statements)

References 25 publications

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“…Compared with arm grafts, thigh grafts had a lower thrombosis rate (1.457 versus 0.543/patient-year) and required fewer total PTAs (1.977 versus 0.881/patient-year) to maintain patency (Table 2). These rates are similar to those reported in the literature (10,11). We speculate that the larger diameter of arteries and veins in the thigh may play a role in the lower thrombosis rate observed.…”

Section: Discussionsupporting

confidence: 91%

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Thigh Grafts Contribute Significantly to Patients' Time on Dialysis

Ram

Sachdeva

Caldito

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Thigh grafts are placed in hemodialysis patients who have exhausted all arm access sites. The goal of this study was to compare the survival, complication rates, and overall contribution of thigh grafts with arm grafts and fistulas in patients with at least one functional thigh graft during their dialysis history.Design, setting, participants, & measurements: This longitudinal review of a prospectively acquired clinical database included 85 thigh graft recipients. The rates of survival, thrombosis, infection, and other complications were determined for a total of 268 fistulas, arm grafts, and thigh grafts placed in these patients.Results: In this patient subset, thigh graft primary failure rate was lower than arm grafts and fistulas (3 versus 13 and 61%, respectively). Excluding primary failures, thigh grafts survived longer than both arm grafts and mature fistulas (53 versus 14 and 32%, at 3 years; 47 versus 3 and 11% at 5 years). Thigh grafts had a lower thrombosis rate than arm grafts (0.543 versus 1.457/patient-year) but similar rates of loss as a result of infection and surgical revision. In patients with previous arm accesses, thigh grafts contributed 51% of total dialysis time compared with 38 and 11% for arm grafts and fistulas.Conclusions: Thigh grafts provide long-term, thrombosis-and infection-free dialysis access for patients with exhausted arm access sites. The decision for thigh graft placement should, therefore, be made as soon as there is evidence for unavailability of arm access sites so that catheter use can be minimized.

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Section: Discussionsupporting

confidence: 91%

“…For example, Miller et al (10) found that arm and thigh grafts had similar median cumulative survival (22.5 versus 27.6 months) in their prospective study. It is possible that the shorter follow-up of some of these studies may have caused underestimation of thigh graft survival.…”

Section: Discussionmentioning

confidence: 96%

Thigh Grafts Contribute Significantly to Patients' Time on Dialysis

Ram

Sachdeva

Caldito

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…We queried the access database retrospectively to identify all thigh arteriovenous grafts placed between January 1, 2003, and June 30, 2011. There was no overlap between the thigh grafts included in this study and those reported previously from our medical center (5). A total of 255 thigh grafts were placed during the 8.5-year study period, for a mean frequency of approximately 30 grafts annually.…”

Section: Discussionmentioning

confidence: 95%

“…All grafts are prone to recurrent stenosis and thrombosis, which can lead to permanent access failure (2), but there are few publications on the outcomes and complication of thigh grafts. Most published studies reported the outcomes of relatively few thigh grafts, with inconsistent definitions of graft outcomes (3)(4)(5)(6)(7)(8)(9)(10)(11). Three larger series (.100 thigh grafts) (12)(13)(14) provided information about graft outcomes using standardized definitions (15) but did not comprehensively analyze clinical factors or comorbid conditions that are associated with thigh graft outcomes.…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcomes of Arteriovenous Thigh Grafts in Hemodialysis Patients

Ong

Barker-Finkel

Allon

2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objective Arteriovenous thigh grafts are a potential vascular access option in hemodialysis patients who have exhausted all upper-limb sites. This study compared the outcomes of thigh grafts with outcomes obtained with dialysis catheters.Design, setting, participants, & measurements A prospective vascular access database was queried to identify 209 thigh grafts placed from January 1, 2003, to June 30, 2011. The following were calculated: secondary graft survival (from graft creation to permanent failure), assisted primary graft survival (from graft creation to first thrombosis), and infection-free graft survival (from graft creation to first graft infection). Graft outcomes were compared with those observed with 472 tunneled internal jugular dialysis catheters.Results The median duration of patient follow-up was 340 days for grafts and 91 days for catheters. The surgical technical failure rate of thigh grafts was 8.1% and was higher in patients with vascular disease (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.07-8.04; P=0.03). Secondary and assisted primary graft survival rates at 1, 2, and 5 years were 62%, 54%, and 38% and 38%, 27%, and 17%, respectively. Infection-free graft survival rates at 1, 2, and 5 years were 79%, 73%, and 61%. Secondary survival was much worse for dialysis catheters than thigh grafts (HR, 4.44; 95% CI,; P,0.001). Likewise, infection-free survival was far worse for catheters than for thigh grafts (HR, 3.77; 95% CI, 2.80-4.82; P,0.001).Conclusions Thigh grafts are a viable vascular option in patients who have exhausted upper-extremity options. Outcomes with thigh grafts are superior to those obtained with dialysis catheters.

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“…In this study, the TCC reference group had the advantage that all TCCs were placed in the internal jugular vein location and the censoring event rate was quite high due to transition to other forms of permanent access. One should also appreciate that an AVG in the upper thigh differs from an upper extremity graft having a higher rate of infections but with similar cumulative patency (11). With these caveats, the results showed that thigh AVGs performed better in terms of patency and infection-free survival then TCCs.…”

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confidence: 97%