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Vascular access for dialysis. Technics and results with newer methods
Insights
For hemodialysis access, the Thomas femoral shunt offered the longest duration but had high infection rates. The Sparks mandril graft is recommended as a secondary option when maturation time allows.
Area of Science:
- Vascular Surgery
- Nephrology
- Medical Device Technology
Background:
- Secondary surgical procedures are crucial for maintaining hemodialysis access in patients with failing primary sites.
- The study population exhibited unique characteristics, including a higher prevalence of females, diabetes, and collagen-vascular diseases compared to the general dialysis population.
Purpose of the Study:
- To compare the durability and complication rates of three secondary hemodialysis access techniques: Thomas femoral shunt, saphenous vein graft, and Sparks mandril graft.
- To identify the most suitable secondary access option based on longevity and clinical outcomes.
Main Methods:
- A retrospective analysis of 114 patients undergoing secondary access operations over five years.
- Life table analysis was employed to compare the duration of utility for each type of graft.
- Patient demographics and complication incidence, particularly septic complications, were recorded and analyzed.
Main Results:
- The Thomas femoral shunt demonstrated the longest duration of utility but was associated with a high incidence of septic complications.
- The Sparks mandril graft showed intermediate durability and utility.
- The saphenous vein graft was found to be the least durable in clinical use.
Conclusions:
- The Sparks mandril graft is tentatively recommended as a primary choice for secondary hemodialysis access, provided sufficient maturation time is available.
- The choice of secondary access should balance the need for longevity with the risk of complications, such as sepsis associated with femoral shunts.
Abstract:
Over a five year period, 114 patients had one or more secondary operations for access to the circulation for hemodialysis, these being a Thomas femoral shunt, saphenous vein graft, or Sparks mandril graft. The patient group was different from the general dialysis population, containing more females, more patients with diabetes, and more patients with collagen-vascular disease. Comparing duration of utility by the life table method for each technic, the femoral shunt lasted longest but with a high incidence of septic complications, the mandril graft was intermediate, and the saphenous vein graft least durable in use. The mandril is considered a tentative first choice for secondary access when the required maturation time is available.