Complications of femoral access for hemodialysis: A surgical perspective

Christian Emeka Amadi 1, * and Dabeluchi Chiedozie Ngwu 2

1 Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
2 Department of Surgery, Federal Medical Centre, Umuahia, Abia State, Nigeria.
 
Research Article
International Journal of Science and Research Archive, 2024, 11(02), 494–500.
Article DOI: 10.30574/ijsra.2024.11.2.0462
Publication history: 
Received on 08 February 2024; revised on 15 March 2024; accepted on 18 March 2024
 
Abstract: 
Background: Vascular access, especially arteriovenous fistula (AVF), is critical for patients requiring haemodialysis. Due to delayed diagnosis, late referral, poverty and limited availability of competent access surgeons, many patients commence haemodialysis without an AVF, hence the frequent use of venous catheters.
Objectives: To assess the pattern of complications associated with repeated femoral punctures for haemodialysis.
Materials and Methods: This is a multicentre prospective study conducted at the Cardiovascular units of the University of Port Harcourt Teaching Hospital, Port Harcourt and Federal Medical Centre, Umuahia between January 2017 and December 2022. 66 patients were recruited for the study. Data obtained were patients’ demography, complications of femoral access, surgical approach and outcome.
Results: 15 patients presented with severe lower limb pains and inability to walk, 10 with fibrosis/ hardening of the skin of both groins, 8 with skin infection at the repeated puncture sites, 12 had Pseudoaneurysm of the superficial femoral artery (SFA), 6 had iatrogenic femoro-femoral Arteriovenous Fistula (AVF) of the SFA and superficial femoral vein (SFV), 5 had groin abscess. All the patients had internal jugular venous catheters inserted. Some patients had Fogarty catheter thrombectomies and interposition Great Saphenous Vein (GSV) graft repairs, while some others had successful takedown of the AVF, Fogarty thrombectomy and direct prolene 6/0 repair of the vein & arterial wall defects. All those that underwent surgical treatment had successful recovery.
Conclusion: Femoral vein cannulation, apparently easy to perform, should not be used as the vascular access of choice for chronic haemodialysis.
 
Keywords: 
Complications; Femoral Access; Pseudoaneurysm; Superficial Femoral Artery; Superficial Femoral Vein
 
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