Objective To summarize the efficacy of lower-extremity arterio-arterial graft (AAG). Methods A retrospective analysis was performed on the clinical data and follow-up outcomes of patients who received lower-extremity AAG in Longhua Hospital Shanghai University of Traditional Chinese Medicine between August 2015 and September 2021. Results A total of 7 patients with AAG were enrolled, with a mean age of (52.1±12.5) years, including 6 females. Six patients received common femoral artery-deep femoral artery AAG, and 1 patient received common femoral artery-superficial femoral artery AAG. All grafts were successfully cannulated for hemodialysis. The follow-up duration ranged from 2 to 77 months, with a mean of (31.6±26.9) months. No limb ischemia occurred during follow-up. Graft thrombosis developed in 6 patients, and stenosis was observed in 6 patients (including distal arterial anastomotic stenosis and cannulation site stenosis). Pseudoaneurysms formed in 4 patients, among whom 1 was complicated by local infection. The 2-year secondary access patency rate was 83.3%. Conclusions Lower-extremity AAG, especially common femoral artery-deep femoral artery AAG, is associated with a low incidence of distal limb ischemia and acceptable patency rates, which can prolong patients’ hemodialysis survival. However, pseudoaneurysms at cannulation sites remain a concern. This alternative access can be cautiously selected in clinical practice.
Objective To analyze the results of the 2024 annual competency assessment of the Hemodialysis Vascular Access Intervention Technique Specialized Training Program, evaluate trainees’ current operational competence, identify weaknesses in the training system, and provide evidence for optimizing the training curriculum. Methods From August to September 2024, trainees underwent offline practical ultrasound examinations at two sites: Chongqing (southern region) and Shijiazhuang (northern region). The examination assessed functional evaluation of arteriovenous fistulas in real maintenance hemodialysis patients, including physical examination and ultrasound evaluation. domestic mainstream ultrasound systems were used, and faculty members conducted one-on-one proctoring. Anonymous questionnaires were administered to examiners and trainees after the examination. Common problems and learning needs were ranked and scored according to severity. Results A total of 223 trainees actually participated in the offline examination, with 17 faculty members supervising the test. Among the 223 trainees, 209 passed the examination, with a pass rate of 93.7%. Examiner survey results indicated that the most prominent common problem was poor ultrasound image quality (score ratio 80.15%), followed by failure to detect clinically significant stenosis during physical examination (69.12%) and unfamiliarity with ultrasound probe manipulation (64.71%). Enhanced practical ultrasound training was identified as the most urgent learning need. Trainee survey results revealed that the most difficult examination item was visualization and diameter measurement of the anastomosis (score ratio 67.94%), while the most significant adverse factor was unfamiliarity with the ultrasound machine brand and operating interface (91.03%). A total of 76.47% of examiners and 80.92% of trainees agreed that standardized operating procedures for arteriovenous fistula physical examination and ultrasound assessment should be established as soon as possible. Conclusions Notable deficiencies were observed in ultrasound image acquisition, accuracy of physical examination, and proficiency in equipment operation. It is recommended to establish standardized operating procedures promptly, strengthen practical ultrasound training and physical examination education, refine scoring criteria, and unify training materials to improve training quality and assessment uniformity.