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Lower Extremity Permanent Dialysis Vascular Access.

Vishal B Parekh1, Vandana D Niyyar1, Tushar J Vachharajani2

  • 1Division of Nephrology, Emory University, Atlanta, Georgia; and.

Clinical Journal of the American Society of Nephrology : CJASN
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Summary

Lower extremity dialysis access is an underutilized option for hemodialysis patients facing upper extremity access challenges. This review explores the pros and cons of lower extremity arteriovenous access to improve long-term dialysis care.

Keywords:
Central Venous CathetersConstriction, PathologicHumansLower Extremityarteriovenous fistulaarteriovenous graftdialysis accessfemoral catheterlower extremity accessnephrologytunneled dialysis cathetervascular access

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Radiology

Background:

  • Hemodialysis is the primary renal replacement therapy (RRT) globally, with improved survival due to technological and care advancements.
  • Maintaining functional upper extremity vascular access is a significant challenge, marked by central venous stenosis and limited permanent access options.
  • Lower extremity permanent dialysis access is underutilized due to factors like surgical skill limitations and nephrologist involvement.

Purpose of the Study:

  • To review the clinical evidence on various lower extremity permanent dialysis access options.
  • To highlight the advantages and disadvantages of these accesses.
  • To inform clinical practice regarding underutilized lower extremity access strategies.

Main Methods:

  • Comprehensive literature review of surgical, radiology, and nephrology publications.
  • Analysis of clinical evidence regarding lower extremity permanent dialysis access.
  • Comparison of arteriovenous fistulas versus synthetic grafts in the lower extremity.

Main Results:

  • Lower extremity arteriovenous fistulas are preferred over synthetic grafts, mirroring upper extremity access preferences.
  • The use of femoral tunneled catheters for long-term access is discouraged, especially with new hybrid devices.
  • Evidence highlights the potential and challenges of various lower extremity access types.

Conclusions:

  • Lower extremity permanent dialysis access presents a viable, yet underused, alternative for hemodialysis patients.
  • Optimizing lower extremity access can address challenges associated with upper extremity vascular access.
  • Further research and clinical adoption are needed to leverage lower extremity access benefits.