Good long-term patency: 10-year follow-up using the mid-thigh adductor loop arteriovenous graft

Abstract

Introduction:

Definitive access in patients requiring renal replacement therapy is an ever-increasing challenge. For those where autogenous venous access is no longer a viable option, arteriovenous grafts can be considered. This article describes long-term follow-up, complications and patency rates of the mid-thigh ‘adductor loop’ arteriovenous graft.

Methods:

50 mid-thigh loop arteriovenous grafts have been inserted into 48 patients in our unit over the past 11 years. A prospective database was collected on patients receiving an arteriovenous graft at our unit by the senior author. All remained under the care of our unit ensuring accurate follow-up data collection and database was updated at regular intervals.

Results:

Death-only censored primary patency at 1, 3 and 5 years was 76%, 44% and 23%, respectively. Patients receiving transplants were not censored as follow-up of the arteriovenous grafts was possible. Secondary patency at 1, 3 and 5 years was 95%, 63% and 45%. These rates are higher than previous studies looking at lower limb arteriovenous grafts. Graft thrombosis occurred in 14 patients (28%). Six patients were treated for an infection (12%) but only four grafts were excised; much lower than documented in previous studies.

Conclusion:

Autogenous venous access remains the perceived gold standard for patients requiring dialysis for end stage renal failure, despite some published data reporting poor outcomes. We have shown that adductor loop arteriovenous grafts can be a reliable, safe and long-term alternative in those whom fistula formation is not possible and may have a role earlier in the patient journey than previously thought, as a result of good patency and lower complications.

Keywords

Arteriovenous access lower limb vascular access polytetrafluoroethylene arteriovenous grafts thigh grafts

Get full access to this article

View all access options for this article.

References

Gilbert

Gibbs

PJ.

Good long term patency rates associated with an alternative technique in vascular access surgery – the adductor loop arteriovenous graft. Eur J Vasc Endovasc Surg 2011; 41(4): 566–569.

Kumwenda

Mitra

Reid

. Vascular access in haemodialysis. 6th ed. The Renal Association, 2015, www.renal.org/guidelines/

Clinical practice guidelines for vascular access. Am J Kidney Dis 2006; 48: 176–247.

Rooijens

Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg 2004; 28(6): 583–589.

Bagul

Brook

Kaushik

et al . Tunnelled catheters for the haemodialysis patient. Eur J Vasc Endovasc Surg 2007; 33(1): 105–112.

Gibbons

CP.

Primary vascular access. Eur J Vasc Endovasc Surg 2006; 31(5): 523–529.

Huijbregts

Bots

Wittens

CHA

et al . Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol 2008; 3: 714–719.

Allon

Robbin

ML.

Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int 2002; 62(4): 1109–1124.

Dember

Beck

Allon

et al . Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 2018; 299(18): 2164–2171.

10.

Geenen

Nyilas

Stephen

et al . Prosthetic lower extremity hemodialysis access grafts have satisfactory patency despite a high incidence of infection. J Vasc Surg 2010; 52(6): 1546–1550.

11.

Parekh

Niyyar

Vachharajani

TJ.

Lower extremity permanent dialysis vascular access. Am Soc Nephrol 2016; 11(9): 1693–1702.

12.

MacRae

Dipchand

Oliver

et al . Arteriovenous access: infection, neuropathy, and other complications. Can J Kidney Health Dis 2016; 3: 1–13.

13.

Aitken

Jackson

Kasthuri

et al . Bilateral central vein stenosis: options for dialysis access and renal replacement therapy when all upper extremity access possibilities have been lost. J Vasc Access 2014; 15(6): 466–473.

14.

Huber

Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review. J Vasc Surg 2003; 38(5): 1005–1011.

15.

Cull

Taylor

et al . Prosthetic thigh arteriovenous access: outcome with SVS/AAVS reporting standards. J Vasc Surg 2004; 39(2): 381–386.

16.

Ong

Barker-Finkel

Allon

Long-term outcomes of arteriovenous thigh grafts in hemodialysis patients: a comparison with tunneled dialysis catheters. Clin J Am Soc Nephro 2013; 8: 804–809.

17.

Tashjian

Lipkowitz

Madden

et al . Safety and efficacy of femoral-based hemodialysis access grafts. J Vasc Surg 2002; 35(4): 691–693.

18.

Antoniou

Lazarides

Georgiadis

et al . Lower-extremity arteriovenous access for haemodialysis: a systematic review. Eur J Vasc Endovasc Surg 2009; 38(3): 365–372.

19.

Schild

Perez

Gillaspie

et al . Arteriovenous fistulae vs. arteriovenous grafts: a retrospective review of 1,700 consecutive vascular access cases. J Vasc Access 2008; 9(4): 231–235.

20.

Ram

Sachdeva

Caldito

et al . Thigh grafts contribute significantly to patients’ time on dialysis. Clin J Am Soc Nephrol 2010; 5(7): 1229–1234.

21.

Aitken

Jackson

Kearns

et al . Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial. Lancet 2016; 388: 1067–1074.

22.

Han

Song

Yun

Long term outcomes of arteriovenous grafts for hemodialysis in lower extremities. Vasc Specialist Int 2016; 32(4): 180–185.

23.

Harish

Allon

Arteriovenous graft infection: a comparison of thigh and upper extremity grafts. Clin J Am Soc Nephrol 2011; 6: 1739–1743.

24.

Scott

Cull

Kalbaugh

et al . The mid-thigh loop arteriovenous graft: patient selection, technique, and results. Am Surg 2006; 72(9): 825–828.

25.

Miller

Robbin

Barker

et al . Comparison of arteriovenous grafts in the thigh and upper extremities in hemodialysis patients. J Am Soc Nephrol 2003; 14(11): 2942–2947.

26.

Aitken

Geddes

Thomson

et al . Immediate access arteriovenous grafts versus tunnelled central venous catheters: study protocol for a randomised controlled trial. Trials 2015; 16: 42.

27.

Glickman

Burgess

Cull

et al . Prospective multicenter study with a 1-year analysis of a new vascular graft used for early cannulation in patients undergoing hemodialysis. J Vasc Surg 2015; 62(2): 434–441.