Technique for a lateral approach to a superficial femoral artery-femoral vein thigh loop arteriovenous graft placement in avoidance of a traditional groin incision

Introduction: The number of patients with end stage renal disease reliant on long-term hemodialysis access continues to grow. When traditional upper extremity hemodialysis sites are exhausted, lower extremity access should be considered. Although autogenous lower extremity options are available, prosthetic lower extremity grafts are frequently used. However, infection can complicate a significant percentage of lower extremity grafts with a traditional groin incision. We present our technique and early results of a lateral approach to a superficial femoral artery-femoral vein thigh loop arteriovenous graft (lat-SFA-FV AVG) in the proximal thigh, which avoids a traditional groin incision and provides a functional access with promising patency. Methods: Between April 2017 and August 2019, five lat-SFA-FV AVG were placed in our institution for arteriovenous access in patients who had exhausted options in upper extremities. Results: Five patients were included in the study. Median SFA size was 8 mm. One patient had moderate SFA calcification, while the other four patients had either none or mild SFA calcification. All grafts were successfully placed with few postoperative complications, including no wound infections. One patient expired 3 weeks after the procedure due to unrelated cause. Three patients had functional grafts at a median follow-up of 499 days. Conclusion: Our early experience demonstrates that the lateral approach to the SFA-FV AVG has several advantages including avoidance of groin infection and acceptable patency. Furthermore, our early experience identifies patient factors which may be important to patient selection for this procedure.