Advances in
hemodialysis technology have allowed application of this treatment modality to an ever-increasing number of patients. Maintaining patients on dialysis for more than a decade is not unusual and the treatment of such patients may be limited primarily by the availability of vascular access. The aim of this study was to assess the efficacy and safety of a
PTFE bridge graft between the superficial femoral artery and vein when more conventional
arteriovenous fistulas cannot be accomplished. Use of the lower extremity had previously been avoided because of a greatly increased risk of
infection. Over the period October 1, 1992 to March 31,1997, we performed 14 of these grafts in 11 patients (6 men and 5 women) whose median age was 56 (range 34-85) years. The patients were on long-term
hemodialysis and vascular access in the upper extremity was not possible. The median time from start of
hemodialysis to receiving a suprapatellary bridge graft was 8 months (range 0-67). The suprapatellary graft was performed on two patients who were just starting on
hemodialysis. Six patients received
PTFE prosthetic implants in both arms and the other three patients underwent both native
arteriovenous fistulas and
PTFE prosthetic implants in the arm before the thigh was used. Only one patient had
diabetes mellitus. Primary patency at 1 year was 54% and at 2 years, 18%. Secondary patency at 1 year was 64% and at 2 years, 18%. A
PTFE bridge graft between the superficial femoral artery and vein for
hemodialysis is a promising alternative when upper extremity
arteriovenous fistulas cannot be constructed. The procedure is easily and rapidly performed with good access, and the patient clientele is easily selected. The technique has not been described previously.