A comparison of arteriovenous grafts and fistulas in lower extremity hemodialysis procedures

Abstract

Objective

Although upper arm hemodialysis access is preferred due to better patency and lower complication rates, femoral access remains necessary for certain patients. This study evaluates the patency rates of femoral hemodialysis access, specifically comparing femoral vein transposition arteriovenous fistula (AVF) and arteriovenous graft (AVG), and identifying factors affecting patency.

Methods

We conducted a retrospective review of patients who received femoral access at our institution from 2006 to 2022. Patency rates were assessed using Kaplan-Meier survival analysis. Risk factors influencing patency were examined through Cox regression modeling, and a comparative analysis between AVF and AVG was performed.

Results

Ninety-one patients received femoral hemodialysis access (mean age, 63 ± 11 years; 57 males). Forty-one had AVF, and 50 had AVG. The overall 12-month and 24-month primary patency rates were 48% and 27%, assisted primary patency rates were 87% and 78%, and secondary patency rates were 90% and 89%. Subgroup analysis showed that femoral AVFs had 50% and 29% primary, 93% and 85% assisted primary, and 97% and 94% secondary patency at 12 and 24 months, respectively. Femoral AVGs demonstrated 44% and 22% primary, 82% and 73% assisted primary, and 84% and 82% secondary patency at 12 and 24 months. There was no significant difference in primary patency between femoral AVFs and AVGs (P = .858). However, the femoral AVF group had higher assisted primary patency (P < .001) and secondary patency (P = .001). Previous femoral vein catheterization on the contralateral side and infection adversely affected secondary patency (hazard ratio, 2.95; 95% confidence interval, 1.43-6.07; P = .002).

Conclusions

Lower extremity hemodialysis access yields excellent secondary patency and patient survival rates, with AVF showing superior assisted primary patency and secondary patency compared with AVG. Femoral vascular access is a viable alternative when upper extremity options are exhausted.