The Thomas shunt revisited.

During a 10-year period, 57 external Thomas femoral shunts (TS) were placed in 43 patients for chronic hemodialysis access. Median shunt survival was 28 months (range, 0.5 to 132). Sixty-three percent (36/57) of shunts are presently functional or functioned until the time of patient death from unrelated cause or removal after renal transplantation. The remaining 37% (21/57) failed after a mean duration of 18 months (range, 2 to 40). Causes of failure were thrombosis (57%), refractory infection (24%), and failure during surgical revision (19%). There were no shunt-related deaths. Race, sex, the presence of diabetes mellitus or hypertension, and prior surgical revision of access did not adversely affect shunt survival. These results support the TS as a viable means of chronic vascular access for hemodialysis patients who cannot receive further upper arm accesses.