Comparative analysis of femoral vein translocation and upper extremity grafts for hemodialysis access

Purpose: Femoral vein translocation (FVT) provides autogenous access in patients who otherwise typically receive upper extremity arteriovenous grafts (AVG) for hemodialysis access. Our objective was to analyze the outcomes of FVT to the upper extremity with upper extremity AVG in patients who lack superficial upper extremity vein for direct fistula creation. Methods: A retrospective review of all patients who underwent upper extremity AVG and FVT to the upper extremity from 2013 to 2023 were analyzed. Study variables included demographic data, medical co-morbidities, follow up (months), patency rates, and complications including graft infection and hemodialysis access-induced distal ischemia (HAIDI). Patency rates were compared with log-rank tests and presented with Kaplan-Meier curves. Results: A total of 240 UE AVG and 100 FVT were included for analysis (83% African American, 17% Caucasian or Hispanic). The mean age was 52 and 61 years for FVT and AVG, respectively. The primary, primary assisted, and secondary patency rates for FVT were 17%, 61%, and 84% compared to 7%, 30%, and 52% in UE AVG at 48 months. Access infection requiring access excision was observed in 6% of FVT compared to 17% for UE AVG ( p = 0.009). In patients with history of graft infection, recurrent access infection was 9% in FVT compared with 28% for repeat AVG. Conclusion: FVT has superior patency rates and less infectious complications compared to UE AVG. FVT is especially useful in patients who have failed multiple AVG from either infection or thrombosis. These comparative outcomes should be considered in patients with a history of graft infection.