Different surgical techniques for lower limb permanent vascular access for hemodialysis

Background Lower limb vascular access is used as a last option after exhaustion of all options and central venous obstruction of both upper limbs. Objectives This study describes our experience about the different techniques for lower limb permanent vascular access for hemodialysis. Patients and methods A prospective study from February 2015 till February 2017 was done on patients with end-stage renal disease with exhausted upper limb vascular access and obstructed central veins who underwent lower limb permanent vascular access for hemodialysis. Different techniques were used according to the patient condition either (a) femoral loop graft by Poly-Tetra-Floro-Ethylene (PTFE) graft, (b) saphenous vein transposition loop fistula, or (c) tunneled femoral vein catheter. Results During the study period, 64 patients were included, with 24 male and 40 female, having a mean age of 63 years. Twenty-two had tunneled femoral vein catheter, 18 had saphenous vein transposition loop fistula, and 24 had femoral loop synthetic graft. The primary patency rate during the first year after access creation was 67, 89, and 67% for the tunneled catheter, saphenous vein transposition loop fistula, and femoral loop synthetic graft, respectively. The infection rate was 22, 11, and 25% for tunneled catheter, saphenous vein transposition fistula, and femoral loop synthetic graft, respectively. Conclusion Lower extremities vascular access is a suitable and durable procedure in patients with exhausted upper limb vascular access and obstructed central veins. Different techniques are available that fit each patient according to his/her examination and evaluation.