الفهرس | Only 14 pages are availabe for public view |
Abstract As the process of hemodialysis needs a vascular access to be done, the patient has to undergo operation to make arteriovenous (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. 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. The two most common types of prosthetic AV lower limbs grafts are the groin fem-fem AV loop graft and mid-thigh AV loop graft. The groin fem-fem AV loop graft revealed High rate of graft excision especially in early postoperative period. So, the trend was to move to the mid –thigh level in order to reduce the risk of infection It seems that the advantage of mid-thigh AV loop graft that carries low infection rates, high patency rates and less reintervention rates. We should consider the groin fem-fem AV loop graft as a last resort after failure of mid-thigh fem-fem AV loop. |