الفهرس 
ANATOMY OF THE FEMOROPOPLITEAL ARTERIAL SEGMENTOnly 14 pages are availabe for public view
 |  | from | 104 |  |  |
| | | from | 104 | | |
Abstract
A
s the process of hemodialysis needs a vascular access to be done, the patient has to undergo operation to make arterio-venous (A-V) access at any suitable site by different methods. Always the upper limb was the first choice of permanent A-V access due to less complications and easy techniques in comparison to other sites.
According to NKF-DOQI recommendations Lower extremity fistula or graft should be done after all upper-arm sites exhausted.
We have many types of A-V accesses in the lower limbs which is either Autogenous accesses like saphenous vein and femoral vein, or Prosthetic accesses in different configurations using superficial femoral, common femoral and popliteal arteries as inflow and using saphenous, superficial femoral and common femoral veins as outflow.
It is evident that the 12-month patency rates of femoral vein transposition arteriovenous fistulae are better than those of both upper- and mid-thigh grafts.
from the existing literature, it appears that the outcomes of lower-extremity arteriovenous access are not significantly inferior to upper-extremity vascular access.
Preoperative screening for peripheral arterial disease with a detailed clinical evaluation and duplex ultrasound scanning and/or arteriography are mandatory when planning A-V construction in the lower limbs.
The most commonly encountered complications associated with lower-extremity arteriovenous access were infection and distal limb ischaemia secondary to steal syndrome.
The most feared complication, particularly associated with prosthetic arteriovenous access construction in the lower extremity, is infection.
Several preventive measures have been proposed to keep infection rates at low levels, including perioperative prophylactic antibiotics and meticulous attention to aseptic technique at the time of cannulation.
It seems that the advantage of autogenous lower-extremity arteriovenous access in terms of infection is offset by the high ischaemic complication rates compared with prosthetic arteriovenous grafts especially occur in diabetic patients with generalised arterial occlusive disease.