Arteriovenous PTFE dialysis access in the lower extremity: a new approach

Advances in hemodialysis technology have allowed application of this treatment modality to an ever-increasing number of patients. Maintaining patients on dialysis for more than a decade is not unusual and the treatment of such patients may be limited primarily by the availability of vascular access. The aim of this study was to assess the efficacy and safety of a PTFE bridge graft between the superficial femoral artery and vein when more conventional arteriovenous fistulas cannot be accomplished. Use of the lower extremity had previously been avoided because of a greatly increased risk of infection. Over the period October 1, 1992 to March 31,1997, we performed 14 of these grafts in 11 patients (6 men and 5 women) whose median age was 56 (range 34-85) years. The patients were on long-term hemodialysis and vascular access in the upper extremity was not possible. The median time from start of hemodialysis to receiving a suprapatellary bridge graft was 8 months (range 0-67). The suprapatellary graft was performed on two patients who were just starting on hemodialysis. Six patients received PTFE prosthetic implants in both arms and the other three patients underwent both native arteriovenous fistulas and PTFE prosthetic implants in the arm before the thigh was used. Only one patient had diabetes mellitus. Primary patency at 1 year was 54% and at 2 years, 18%. Secondary patency at 1 year was 64% and at 2 years, 18%. A PTFE bridge graft between the superficial femoral artery and vein for hemodialysis is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. The procedure is easily and rapidly performed with good access, and the patient clientele is easily selected. The technique has not been described previously.