Dumaine Chance, Espino-Hernandez Gabriela, Romann Alexandra, Luscombe Rick, Kiaii Mercedeh
Division of Nephrology, Department of Medicine, St. Paul's Hospital, University of Saskatchewan, Saskatoon, Canada.
British Columbia Provincial Renal Agency, Vancouver, Canada.
Can J Kidney Health Dis. 2017 Jul 25;4:2054358117719747. doi: 10.1177/2054358117719747. eCollection 2017.
Femoral arteriovenous grafts are rarely used to provide vascular access for dialysis patients. This is likely due, in part, to historically high rates of graft loss from infection and thrombosis. However, for selected patients who have exhausted all access options in the upper extremity, femoral grafts can provide additional sites for access creation and may be preferred over central venous catheters.
We sought to demonstrate that femoral grafts can provide a reliable and safe alternative to central venous catheters for selected patients.
A single-center retrospective review in Vancouver, Canada, from April 1, 2008, to March 31, 2012, was conducted. All patients with new arteriovenous access (grafts and fistulas) created during the study period were included in the study population and followed for a minimum of 2 years. Comparisons of patency (primary, secondary, and functional) and complications (infectious and noninfectious) were made between the different access types.
Thirteen patients with femoral grafts were compared with 22 patients with arm grafts and 384 patients with fistulas. Femoral grafts had higher rates of thrombosis (46% with a thrombotic event) and a higher requirement for interventions (1.3 angioplasties and 0.12 thrombolytic procedures per patient per year). However, compared with arm grafts, femoral grafts had superior secondary and functional patency. No difference in patency was seen when comparing femoral grafts with upper extremity fistulas. Only 2 patients with femoral grafts required antibiotics for infection, and no grafts were lost to infection.
For patients with limited access options remaining, femoral grafts may provide an additional form of vascular access before resorting to catheter use. Our study shows that with appropriate patient selection, femoral grafts have low infection rates and patency that is comparable with other access types.
股动静脉移植物很少用于为透析患者提供血管通路。这可能部分归因于历史上因感染和血栓形成导致的移植物丢失率很高。然而，对于上肢所有通路选择均已用尽的特定患者，股动静脉移植物可为建立通路提供额外的部位，并且可能比中心静脉导管更受青睐。
我们试图证明，对于特定患者，股动静脉移植物可为中心静脉导管提供可靠且安全的替代方案。
在加拿大温哥华进行了一项单中心回顾性研究，研究时间为2008年4月1日至2012年3月31日。研究期间所有新建动静脉通路（移植物和内瘘）的患者均纳入研究人群，并至少随访2年。对不同通路类型的通畅率（初级、次级和功能通畅率）和并发症（感染性和非感染性）进行比较。
将13例使用股动静脉移植物的患者与22例使用上肢移植物的患者以及384例使用内瘘的患者进行比较。股动静脉移植物的血栓形成率更高（46%发生血栓事件），干预需求也更高（每位患者每年进行1.3次血管成形术和0.12次溶栓治疗）。然而，与上肢移植物相比，股动静脉移植物的次级通畅率和功能通畅率更高。将股动静脉移植物与上肢内瘘进行比较时，通畅率无差异。只有2例使用股动静脉移植物的患者因感染需要使用抗生素，且没有移植物因感染而丢失。
对于通路选择有限的患者，股动静脉移植物可能在使用导管之前提供另一种血管通路形式。我们的研究表明，通过适当选择患者，股动静脉移植物感染率低，通畅率与其他通路类型相当。
