Outcome of upper limb arteriovenous prosthetic graft versus lower limb arteriovenous access for hemodialysis in patients with exhausted vascular accesses

Introduction: The recommended treatment for patients who have exhausted all options for native fistula access is the use of a synthetic prosthesis to create an arteriovenous brachial-axillary graft on the upper arm or a brachial-brachial loop graft on the forearm. Additionally, the lower extremity is being used more frequently as an access site in patients with end-stage renal disease. Nevertheless, the papers exhibit divergent findings, leading to ambiguity regarding the practicability and consequences. Our goal is to compare the two methods and analyze the rates of patency and complications. Methods: A comparison was made between patients who underwent arteriovenous graft (AVG) procedures from August 2018 to August 2021 and those who obtained lower limb native access throughout the same time frame. This study included forty patients with end-stage chronic renal failure who have depleted cephalic and basilic veins. There are two groups: group (A) consisting of a PTFE graft in the brachial artery and axillary vein. (B) Twenty cases of lower limb arteriovenous access. Results: There was no statistical difference between the two study groups regarding basal characteristics. In group A, the mean age was 56.8 years with an SD of 13.4. most of the participants (70%) were males. DM prevalence reached 70%. In group B, the mean age was 53.9 years with an SD of 3.9. 60% of participants were females. DM prevalence reached 45%. Regarding complications no significant difference was found. Conclusion: No significant difference between the two groups but this needs more randomized trials to confirm.