Prosthetic thigh arteriovenous access: outcome with SVS/AAVS reporting standards

Cull, John D.; Cull, David L.; Taylor, Spence M.; Carsten, Christopher G.; Snyder, Bruce A.; Youkey, Jerry R.; Langan, Eugene M.; Blackhurst, Dawn W.

doi:10.1016/s0741-5214(03)00720-1

Cited by 78 publications

(104 citation statements)

References 9 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%

“…Because grafts are preferable to catheters, it is conceivable that thigh grafts would benefit these patients. Thus, several studies have shown that the outcome of thigh grafts is similar to concurrent or historic arm grafts (9 -12); however, there is a general reluctance to thigh graft placement because of the prevailing impression of poor performance or associated risks for infection or leg ischemia (9,11).…”

mentioning

confidence: 99%

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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%

mentioning

confidence: 99%

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 found no significant association of secondary survival, primary assisted survival, or infection-free graft survival with patient age, sex, race, diabetes, vascular disease, or heart failure. In agreement with our findings, another large series (125 grafts) found no significant association of secondary graft patency with patient age, sex, race, or diabetes, but that study did not look at vascular disease or heart failure (12). Likewise, another large series (153 grafts) observed no significant association between thigh graft infection and patient age, sex, diabetes, or coronary artery disease (14).…”

Section: Discussionsupporting

confidence: 89%

“…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. Finally, none of the published reports directly compared the outcomes of thigh grafts and tunneled dialysis catheters.…”

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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“…Previous reports of survival after ePTFE graft implantation range from 53 to 96 per cent 20,21 compared with 62 per cent for biological grafts 22 . Another xenograft conduit, the ProCol  bovine mesenteric vein graft (Hancock Jaffe Laboratories, Irvine, California, USA) had patient survival rates of 77 and 86 per cent 23,24 .…”

Section: Discussionmentioning

confidence: 94%