Can a patient undergo dialysis through the femoral artery?

Dialysis Access Through the Femoral Artery: Not Recommended

Dialysis should not be performed through the femoral artery as it is not an appropriate access site for hemodialysis. 1 Hemodialysis requires venous access, not arterial access, for safe and effective treatment.

Appropriate Vascular Access Options for Hemodialysis

Preferred Access Sites

• The right internal jugular vein is the preferred site for tunneled dialysis catheter placement due to its direct route to the right atrium and lower risk of complications compared to other sites 1, 2
• For urgent temporary dialysis access, noncuffed catheters can be placed in the internal jugular vein (usable for up to 1 week) or femoral vein (usable for up to 5 days in bed-bound patients) 1
• When upper extremity access options are exhausted, tunneled cuffed femoral venous catheters may be placed as a temporary measure until permanent access is created 1

Contraindicated Access Sites

• The subclavian vein should be avoided for dialysis access due to high risk of central venous stenosis or occlusion 1
• The femoral artery is not an appropriate site for dialysis access as standard hemodialysis requires a venous circuit 1

Femoral Vein Access Considerations

• In urgent situations when upper extremity access is unavailable, the KDOQI guidelines suggest that placement of a tunneled cuffed femoral venous catheter (not arterial) may be acceptable for short-term use until permanent AV access is created and usable 1
• Femoral vein catheters are associated with higher infection rates compared to other sites and should be limited to short-term use 1
• To minimize recirculation, femoral catheters should be at least 19 cm long to reach the inferior vena cava 1

Alternative Lower Extremity Access Options

For patients who have exhausted all conventional access options, there are specialized alternatives that may involve the femoral artery, but these are not standard dialysis catheters:

• Arterioarterial prosthetic loops (AAPL) using the femoral artery can be surgically created as a last resort option for selected patients 3
• Femoral artery to femoral vein bypass grafts have been described as specialized surgical procedures for chronic access, not as catheter placements 4, 5
• In extreme emergencies when all venous access is exhausted, temporary femoral artery catheterization has been reported in case studies, but this is highly unusual and carries significant risks 6

Important Considerations and Risks

• Femoral artery catheterization for dialysis carries high risks of:

  • Distal limb ischemia 6
  • Bleeding complications 6
  • Arterial thrombosis 1
  • Potential limb loss, especially in patients with peripheral arterial disease 5

• Any decision to use the femoral vessels for dialysis access should be undertaken with great care, especially in patients who may be candidates for kidney transplantation, as femoral vessel complications could affect future transplant options 1

Best Practice Recommendations

• For urgent dialysis access when conventional sites are unavailable, consult with vascular surgery or interventional radiology for placement of a tunneled venous catheter in an alternative location 1
• Ultrasound guidance should always be used for vascular access placement to minimize complications 7, 2
• In patients requiring long-term dialysis with exhausted upper extremity access options, creation of a surgical arteriovenous access in the lower extremity by vascular surgery is preferable to long-term catheter use 1, 5