Challenges in vascular access: Lower extremity options

Lower limb vascular access is an alternative option when the upper limb is either not available or desirable. Larger blood vessels, relatively insensate lateral aspect of the thigh, relative comfort during hemodialysis related to not having to use the arms and avoiding upper limb scars are some of the attributes that make the lower limb an attractive option in selected patients. This chapter provides a broad overview of a variety of lower limb access options described in the literature. The selection of the most appropriate lower limb access modality for each patient must involve consideration of the arterial and venous anatomical limitations, with equal importance placed on the ease of use of the cannulatable conduit.