Thigh arteriovenous grafts. Quantitative comparison with alternative options: A meta-analysis

Area of Science:

• Vascular Surgery
• Nephrology
• Dialysis Access

Background:

• Thigh arteriovenous grafts (AVGs) are utilized for hemodialysis access in patients with exhausted upper extremity veins, representing 1-5% of total access procedures.
• Alternative lower extremity options include sapheno-tibial arteriovenous fistulae, saphenous vein transpositions, and femoral vein transpositions.

Purpose of the Study:

• To evaluate the efficacy and durability of thigh grafts compared to alternative lower limb access options.
• To compare thigh grafts with the HeRO® device.

Main Methods:

• A literature search was conducted to identify relevant studies on lower limb vascular access.
• A meta-analysis was performed to compare primary failure rates and infection rates between different access types.

Main Results:

• Autogenous lower limb accesses, specifically femoral vein transpositions, demonstrated high durability with primary patency rates of 74-87% at 2 years and low infection rates.
• Synthetic thigh grafts have secondary patency rates of 54-83% at 2 years but are associated with a high average infection rate of 22.9%.
• Lower limb accesses showed a significantly lower 1-year primary failure rate compared to the HeRO® device (OR=0.28, CI=0.09-0.88, p=0.03).
• Autogenous lower limb accesses were significantly superior to thigh grafts regarding the 1-year primary failure rate (OR=6.54, CI=2.29-18.72, p=0.0005).

Conclusions:

• Autogenous lower limb vascular access procedures, particularly femoral vein transpositions, offer superior durability and lower failure rates compared to synthetic thigh grafts.
• Synthetic thigh grafts should be considered for patients unsuitable for upper limb or autogenous lower limb access, despite higher infection risks and failure rates.
• Lower limb accesses represent a viable and effective alternative for hemodialysis access in select patient populations.