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The Thomas shunt revisited.

B I Freedman¹, R L Anderson, A B Tuttle

¹Department of Internal Medicine/Nephrology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1053.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation

|January 1, 1992

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External Thomas femoral shunts (TS) offer a viable vascular access for hemodialysis patients. These shunts demonstrated a median survival of 28 months with a 63% success rate.

Area of Science:

Nephrology
Vascular Surgery
Medical Devices

Background:

Chronic hemodialysis necessitates reliable vascular access.
Patients with limited upper arm access options require alternative solutions.
External shunts, like the Thomas femoral shunt (TS), have been used for this purpose.

Purpose of the Study:

To evaluate the long-term efficacy and survival of external Thomas femoral shunts (TS) for chronic hemodialysis access.
To identify factors influencing shunt survival and failure modes.

Main Methods:

Retrospective analysis of 57 external Thomas femoral shunts (TS) placed in 43 patients over a 10-year period.
Data collection on shunt placement, duration of function, failure causes, and patient demographics.
Survival analysis to determine median shunt survival and success rates.

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Main Results:

Median shunt survival was 28 months (range, 0.5-132 months).
Sixty-three percent of shunts remained functional or functioned until patient death/transplantation.
Primary failure causes included thrombosis (57%), infection (24%), and surgical revision issues (19%); no shunt-related deaths occurred.

Conclusions:

The external Thomas femoral shunt (TS) is a viable and safe option for chronic hemodialysis vascular access, particularly for patients with exhausted upper extremity access.
Patient-specific factors like race, sex, diabetes, hypertension, and prior revisions did not negatively impact shunt survival.
Further research into optimizing shunt longevity and minimizing thrombosis/infection is warranted.