Safety and efficacy of femoral-based hemodialysis access grafts

Objective: Arteriovenous fistulae traditionally have been placed in the upper extremity. Experience with groin hemodialysis access has been discouraging because of high infection rates and associated limb amputation. We reviewed our experience with angioaccess grafts in the groin to assess safety and viability in our hemodialysis patient population. Methods: A retrospective review was performed of all groin hemodialysis access grafts placed at a single tertiary care center between June 1990 and February 1998. Demographics, complications, and subsequent treatment were recorded. Graft patency and infection rates were analyzed with life-table analysis. Results: Data were collected on 73 graft insertions. A total of 52 episodes of thrombosis occurred in 26 grafts. Primary patency rate was 71% at 1 year. Secondary patency rate was 83% at 1 year. There was a 22% incidence rate of infection. Conclusion: We conclude that the incidence rate of infection and thrombosis in our series of femoral-based hemodialysis grafts is comparable with rates reported in the literature for upper extremity polytetrafluoroethylene angioaccess grafts. Although not considered a first choice, femoral artery based hemodialysis access is a viable option when arteriovenous fistulae in the upper extremity cannot be constructed.