Introduction: It is unclear how to manage high risk hemodialysis patients who present with an indwelling catheter. The National Kidney Foundation Practice Guidelines urge prompt removal of the catheter, but the guidelines do not specifically address the problem of patients whose only option is a femoral arteriovenous (AV) graft.
Methods: This study was a retrospective review of all patients who underwent femoral AV graft placement for hemodialysis access between January 1, 1996 and January 1, 2003 at the University of Michigan Health System (UMHS). Graft patency is reported according to the standards developed by the Society of Vascular Surgery and the American Association of Vascular Surgeons.
Results: Thirty patients were identified who had undergone femoral AV graft placement. The mean follow-up was 23 months (range 1-75 months). The patients had had significant medical co-morbidities and multiple previous access operations (mean 3; interquartile range 1-5). The 1-year secondary graft patency rate was 41%, the 2-year rate was 26%, and the 3-year rate was 21%. Infection was the cause of final graft loss in eight patients (50% of the grafts losses, 27% of the total grafts placed.) Among those who died (n=14), the mean time from femoral graft placement to death was 31.2+/-27.5 months. The patient survival was quite low: at 1 year 81%, at 2 years 68%, and at 3 years 54%.
Conclusions: These complex patients who have exhausted their upper extremity hemodialysis options do poorly following femoral AV graft placement. Consideration should be given to long-term catheter-based access in some of these patients.