Complications of Lower Extremity Arteriovenous Grafts
Complications of Lower Extremity Arteriovenous Grafts
Background: More data are needed to assess lower extremity angioaccess sites for hemodialysis.
Methods: We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996.
Results: Lower extremity grafts accounted for 16% (134/843) of patients in this series. Complications occurred in 58 of 134 patients (43%) and were more prevalent in women, blacks, diabetic, and hypertensive patients, but not of statistical significance. Dialysis was done for a mean duration of 13.3 years, with a mean graft patency rate of 13.8 months. The 12-month survival rate of lower extremity AV grafts was 62% (83/134). Complications in the lower extremity AV graft group (58 patients) included infections in 27 patients (46%), thrombosis within 30 days in 16 (28%), pseudoaneurysm in 9 (16%), and graft hemorrhage in 6 (10%).
Conclusions: There is a decreased patency rate in lower extremity AV grafts.
Over the past 20 years, vascular surgeons have done increased numbers of angioaccess procedures for long-term hemodialysis in patients with end-stage renal disease (ESRD). The Health Care Financing Administration estimates that more than 300,000 patients will be enrolled in ESRD Medicare programs by the year 2000. The increasing longevity of the population, coupled with the larger number of patients requiring hemodialysis for ESRD, necessitates evaluating the potential access sites available for patients to maintain long-term angioaccess.
Investigators have gathered little data on the complications of lower extremity angioaccess sites. Traditionally, the lower extremity has been used only as an alternate angioaccess site when both upper extremities have been exhausted or a secondary medical condition precludes use of the upper extremity. Zibari et al found decreased patency rates for lower extremity polytetrafluorethylene (PTFE) grafts compared with upper extremity autogenous AV fistulas. The purpose of this study is to assess the patency and complications of lower extremity grafts in a group of patients with ESRD.
Background: More data are needed to assess lower extremity angioaccess sites for hemodialysis.
Methods: We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996.
Results: Lower extremity grafts accounted for 16% (134/843) of patients in this series. Complications occurred in 58 of 134 patients (43%) and were more prevalent in women, blacks, diabetic, and hypertensive patients, but not of statistical significance. Dialysis was done for a mean duration of 13.3 years, with a mean graft patency rate of 13.8 months. The 12-month survival rate of lower extremity AV grafts was 62% (83/134). Complications in the lower extremity AV graft group (58 patients) included infections in 27 patients (46%), thrombosis within 30 days in 16 (28%), pseudoaneurysm in 9 (16%), and graft hemorrhage in 6 (10%).
Conclusions: There is a decreased patency rate in lower extremity AV grafts.
Over the past 20 years, vascular surgeons have done increased numbers of angioaccess procedures for long-term hemodialysis in patients with end-stage renal disease (ESRD). The Health Care Financing Administration estimates that more than 300,000 patients will be enrolled in ESRD Medicare programs by the year 2000. The increasing longevity of the population, coupled with the larger number of patients requiring hemodialysis for ESRD, necessitates evaluating the potential access sites available for patients to maintain long-term angioaccess.
Investigators have gathered little data on the complications of lower extremity angioaccess sites. Traditionally, the lower extremity has been used only as an alternate angioaccess site when both upper extremities have been exhausted or a secondary medical condition precludes use of the upper extremity. Zibari et al found decreased patency rates for lower extremity polytetrafluorethylene (PTFE) grafts compared with upper extremity autogenous AV fistulas. The purpose of this study is to assess the patency and complications of lower extremity grafts in a group of patients with ESRD.
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