A new access, Dermatorrhea, 10 samples of the great saphenous vein

Abstract

We devised a method that enables blood removal/return by creating a fistula between the skin and the great saphenous vein to insert the dialysis needle sheath in the femoral vein under ultrasonography guidance with respect to each dialysis. We report the principles, methods, and cases. A skin-great saphenous vein fistula is created under local anesthesia. It is used for blood removal/return during maintenance hemodialysis performed immediately after creating the fistula. Ten limbs of 10 patients (three men and seven women; mean age, 77.6 ± 4.8 years; dialysis history, 9.9 ± 13.0 years), where skin-great saphenous vein fistulas were created in our hospital between May 2017 and June 2018, were included. In all the cases, an arteriovenous fistula or arteriovenous graft was difficult to create because of the general condition and/or vascular fitness of the patients. During or after the fistula-creating surgery, no serious complications were found. No complications such as blood removal failure, infection, or hemorrhage were found during the follow-up period. The primary patency rates by the Kaplan–Meier method were 100% at 3 months and 67.5% at 6 months. This method is considered a valuable substitute method for cases with difficulty in creating a vascular access.

Evaluation of venocutaneous fistula as vascular access for hemodialysis: Examination of 46 limbs of 40 patients

“… 1 , 8 – 10 It is said that thrombi in central venous catheters are closely associated with infections. 3 With the VCF method, a closed venous lumen was observed because of the progression of vascular wall thickening associated with venous valve function and mechanical stimulation. Therefore, there was no involvement of foreign matter such as dead spaces or thrombi in the occurrence and spread of infection, and this resulted in the low incidences of tunnel infection and bloodstream infection.…”

“…It was therefore defined, based on the guidelines stated in KDOQI 2019, 1 CDC for cuffed catheter infection. 3 …”

“…It was therefore defined, based on the guidelines stated in KDOQI 2019, 1 CDC for cuffed catheter infection. 3 A basilic vein-skin fistula was created in one patient. (…”

“…In 2019, we reported 10 patients who were subsequently treated with this method. 3 Here, we report the results of fistula creation and routine dialysis management after refining the method and the device and after obtaining mid- and long-term results. The previous report was characterized by a short time to hemostasis and low incidence of infections.…”