Lower limb vascular access for maintenance hemodialysis patients – A case series

Abstract

The vascular access is considered as Achilles heel of a successful maintenance hemodialysis (MHD) program. Although it is ideal to initiate the dialysis through arteriovenous fistula (AVF), many of the patients start initiation through central venous catheters which predispose them later to multiple access complications. Also, as the elderly population has poor vasculature to support AVF, many of them end up exhausting all upper limb vascular accesses. As a result, there are a group of MHD patients with difficulty in using upper limb vascular access secondary to multiple access failure who are otherwise unable to switch to another modality of renal replacement therapy completely and have to rely on lower limb vascular access as a last resort to sustain life. We would like to share our experience on lower limb vascular access in our institute. The three types of lower limb vascular accesses include lower limb AVF, lower limb AV graft, and tunneled femoral vein catheter as illustrated in three patients with a successful utilization in sustaining life.

Keywords

• lower limb vascular access
• maintenance hemodialysis
• multiple access failure