الفهرس 
Anatomy of the Femorol Artery
INDICATIONS OF PROSTHETIC LOWER EXTREMITIES ARTERIO-VENOUS ACCESSESOnly 14 pages are availabe for public view
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Abstract
As the process of hemodialysis needs a vascular access to
be done, the patient has to undergo operation to make arteriovenous
(A-V) access at any suitable site by different methods.
Always the upper limb was the first choice of permanent A-V
access due to less complications and easy techniques in
comparison to other sites.
According to NKF-DOQI recommendations Lower
extremity fistula or graft should be done after all upper-arm sites
exhausted.
We have many types of A-V accesses in the lower limbs
which is either Autogenous accesses like saphenous vein and
femoral vein, or Prosthetic accesses in different configurations
using superficial femoral, common femoral and popliteal arteries
as inflow and using saphenous, superficial femoral and common
femoral veins as outflow.
from the existing literature, it appears that the outcomes
of lower-extremity arteriovenous access are not significantly
inferior to upper-extremity vascular access. Preoperative
screening for peripheral arterial disease with a detailed clinical
evaluation and duplex ultrasound scanning and/or arteriography
are mandatory when planning A-V construction in the lower
limbs.The most commonly encountered complications
associated with lower-extremity arteriovenous access were
infection and distal limb ischaemia secondary to steal syndrome.
The most feared complication, particularly associated with
prosthetic arteriovenous access construction in the lower
extremity, is infection.
Several preventive measures have been proposed to keep
infection rates at low levels, including perioperative prophylactic
antibiotics and meticulous attention to aseptic technique at the
time of cannulation. The two most common types of prosthetic
AV lower limbs grafts are the groin fem-fem AV loop graft and
mid-thigh AV loop graft.
The groin fem-fem AV loop graft revealed High rate of
graft excision especially in early postoperative period. So, the
trend was to move to the mid –thigh level in order to reduce the
risk of infection
It seems that the advantage of mid-thigh AV loop graft
that carries low infection rates, high patency rates and less reintervention
rates. We should consider the groin fem-fem AV
loop graft as a last resort after failure of mid-thigh fem-fem AV
loop.