BACKGROUND 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, 3.65-5.22; 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.
BACKGROUND 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, 3.65-5.22; 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.
Authors: Anton N Sidawy; Richard Gray; Anatole Besarab; Mitchell Henry; Enrico Ascher; Michael Silva; Arnold Miller; Larry Scher; Scott Trerotola; Roger T Gregory; Robert B Rutherford; K Craig Kent Journal: J Vasc Surg Date: 2002-03 Impact factor: 4.268
Authors: David B Tashjian; George S Lipkowitz; Robert L Madden; Jeffrey L Kaufman; Sang Won Rhee; Joel Berman; Marc Norris; Jane McCall Journal: J Vasc Surg Date: 2002-04 Impact factor: 4.268
Authors: G B Zibari; M S Rohr; M D Landreneau; R M Bridges; G A DeVault; F H Petty; K J Costley; S T Brown; J C McDonald Journal: Surgery Date: 1988-10 Impact factor: 3.982
Authors: John D Cull; David L Cull; Spence M Taylor; Christopher G Carsten; Bruce A Snyder; Jerry R Youkey; Eugene M Langan; Dawn W Blackhurst Journal: J Vasc Surg Date: 2004-02 Impact factor: 4.268
Authors: Jennifer M MacRae; Christine Dipchand; Matthew Oliver; Louise Moist; Serdar Yilmaz; Charmaine Lok; Kelvin Leung; Edward Clark; Swapnil Hiremath; Joanne Kappel; Mercedeh Kiaii; Rick Luscombe; Lisa M Miller Journal: Can J Kidney Health Dis Date: 2016-09-27