Saphenous vein loop to femoral artery arteriovenous fistula: a practical alternative.

Abstract:

:Secondary to central venous stenosis or thrombosis, alternate sites for permanent hemodialysis need to be explored. The authors' experience with the greater saphenous vein to common femoral artery loop arteriovenous fistula (GSV-CFA AVF) is presented. A retrospective review was performed of 4 women and 3 men with a mean age of 52.7 (range, 44-68) years. The mean number of prior access procedures was 3.85 (range, 1-5). Duplex ultrasound showed the greater saphenous vein (GSV) to be at least 3 mm in diameter. Perioperatively, no acute occlusion or significant steal syndrome developed. Groin wound complications (57.1%) resolved with local wound care and selectively antibiotic administration. Six patients developed mild to moderate edema, which required knee-high compression stockings. The mean follow-up was 15 (range, 9-24) months. Mean primary patency was 7 months, primary assisted patency was 15 months, and secondary patency was 16 months. The fistula was functional for hemodialysis in 71.4% (5/7). All patients developed stenoses within the GSV loop, with a mean of 3.0 balloon angioplasties per fistula. Three secondary surgical procedures were performed (two pseudoaneurysm repairs, one vein patch angioplasty). The GSV did not increase significantly in diameter. Use of a GSV-CFA AVF for dialysis access has acceptable results for alternate-site hemodialysis access. Secondary procedures were common. Factors recognized to be important for success were an adequate-sized GSV preoperatively, positioning of the GSV loop, and patient body habitus.

journal_name

Ann Vasc Surg

authors

Pierre-Paul D,Williams S,Lee T,Gahtan V

doi

10.1007/s10016-004-0016-7

subject

Has Abstract

pub_date

2004-03-01 00:00:00

pages

223-7

issue

2

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(06)61124-2

journal_volume

18

pub_type

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