Comparing the outcomes of femoral vein transposition versus lower extremity arteriovenous graft in dialysis patients with exhausted upper extremity access

Abstract

Introduction

Finding suitable vascular access for dialysis is a significant challenge in advanced kidney failure. Patients with end-stage renal disease (ESRD) need urgent lower extremity vascular access. This study compares the outcomes of Femoral vein transposition (FVT) and Arterovenous Grafts (AVG) in patients without viable upper limb access, in alignment with KDOQI guidelines and individualized Life Plan strategies.

Materials and Methods

A retrospective study involving 52 patients with end-stage renal disease (ESRD) and no suitable upper extremity access, including those with suitable femoral veins or adequate lower extremity vasculature, analyzed either FVT (n = 26) or lower extremity AVG (n = 26) over a one-year period. The procedure involved freeing the femoral vein, transferring it to a subcutaneous tunnel in the thigh, and connecting it to the femoral artery. Outcomes measured were success rate, complications, and primary and secondary patency rates over nine months.

Results

In our study, 26 patients were evaluated, comprising 14 (53.8 %) males and 12 (46.2 %) females. The mean age of the patients was 60.32 years. At the 9-month follow-up, successful dialysis was achieved in 92.3 % of FVT cases compared to 53.8 % of AVG cases (p = 0.001). Primary patency was significantly higher in FVT (84.6 %) than AVG (50 %) (p = 0.01). Notably, no thrombosis or infection occurred in FVT patients, whereas the AVG group experienced 26.9 % thrombosis and 11.5 % infection. Wound healing complications were more frequent in the FVT group (42.3 % vs. 15.4 %, p = 0.032), though all resolved with conservative

Discussion

The FVT procedure has shown a high success rate and low complication rate, making it a viable option for patients lacking upper extremity vascular access. However, its complexity and limited familiarity among practitioners have hindered broader adoption. Our findings confirm that with proper training, FVT can significantly benefit patients with advanced chronic kidney disease (CKD) who need reliable dialysis access, highlighting its potential to the medical community.

Conclusion

Our study demonstrated that AVG remains a viable option when FVT is contraindicated. FVT is a low-complication and reliable method for establishing dialysis access in patients with no upper extremity vascular access.