Femoral vein transposition for arteriovenous hemodialysis access: Improved patient selection and intraoperative measures reduce postoperative ischemia

Gradman, Wayne S.; Laub, Judith; Cohen, William N.

doi:10.1016/j.jvs.2004.10.039

Cited by 92 publications

(71 citation statements)

References 18 publications

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“…Gradman et al (14,15) reported a low thrombosis rate in 25 patients with transposed superficial femoral vein (tFV) AVF with mean follow-up of 9.1 months. The cumulative primary and secondary fistula patency rates were 78% and 73% at 6 and 12 months and 91% and 86% at 6 and 12 months, respectively.…”

Section: Transposed Femoral Vein Le-avfmentioning

confidence: 99%

“…The cumulative primary and secondary fistula patency rates were 78% and 73% at 6 and 12 months and 91% and 86% at 6 and 12 months, respectively. One patient needed above knee amputation for acute compartment syndrome, and eight patients required a second surgery for distal limb ischemia (14,15). Rueda et al (16) reported 10 patients with tFV LE-AVF accesses, and none had a lower extremity ischemic event.…”

Section: Transposed Femoral Vein Le-avfmentioning

confidence: 99%

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Lower Extremity Permanent Dialysis Vascular Access

Parekh

Niyyar

Vachharajani

2016

CJASN

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Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Frequently encountered difficulties in clinical practice include (1) a high incidence of central venous catheter-related central vein stenosis and (2) limited options for creating a functioning upper extremity permanent arteriovenous access. Lack of surgical skills, fear of complications, and limited involvement of the treating nephrologists in the decision-making process are some of the reasons why lower extremity permanent dialysis access remains an infrequently used option. Similar to upper extremity vascular access options, lower extremity arteriovenous fistula remains a preferred access over arteriovenous synthetic graft. The use of femoral tunneled catheter as a long-term access should be avoided as far as possible, especially with the availability of newer graft-catheter hybrid devices. Our review provides a summary of clinical evidence published in surgical, radiology, and nephrology literature highlighting the pros and cons of different types of lower extremity permanent dialysis access.

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Section: Transposed Femoral Vein Le-avfmentioning

confidence: 99%

Section: Transposed Femoral Vein Le-avfmentioning

confidence: 99%

Lower Extremity Permanent Dialysis Vascular Access

Parekh

Niyyar

Vachharajani

2016

CJASN

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“…However, if the upper limb use is not appropriate, axillary-axillary AV access (necklace graft) (25), superficial femoral vein transposition (26), axillary artery to right atrial graft (27), hemodialysis reliable outflow graft (28), and femoral AV graft could be used as alternative choices for vascular access (19)(20)(21). Autogenous AV fistula or graft AV fistula are available for femoral AV access, although the former is not preferred because of wide incision and associated complications (19,29,30).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transluminal angioplasty for dysfunctional femoral hemodialysis graft

Kim²,

Goo³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate the safety and effectiveness of percutaneous transluminal angioplasty (PTA) for dysfunctional femoral arteriovenous graft and analyze clinical or anatomic predictors of graft patency. METHODSThe records of 45 patients who underwent PTA or thromboaspiration for dysfunctional or thrombosed femoral arteriovenous graft from 2005 to 2012 were reviewed retrospectively. Primary and secondary patency rates were determined at three, six, and 12 months after PTA. The primary patency rate was analyzed according to the presence of diabetes mellitus, graft age from the time of creation to the first intervention (<12 months or ≥12 months), presence of thrombus, shape of graft (U-shape vs. straight-shape), anastomosis type of graft (femoral-femoral vs. femoral-saphenous), location of stenosis (central vs. peripheral), length of stenosis (<2 cm vs. ≥2 cm), degree of stenosis severity (<70% vs. ≥70%), and stent insertion. RESULTSA total of 124 PTAs were performed in 45 patients. The primary patency rate at three, six, and 12 months was 84.8%, 63.6%, and 24.2%, respectively. The secondary patency rate at three, six, and 12 months was 95.2%, 95.2%, and 85.7%, respectively. The mean duration of primary and secondary patency was 13.2 and 35.7 months, respectively. No significant clinical or anatomical predictors of primary patency could be identified. Stent placement had a negative effect on primary patency. CONCLUSION PTA is a safe and effective treatment for dysfunctional femoral arteriovenous grafts. Stent placement seems to improve technical success, but does not enhance the primary patency rate of dysfunctional femoral arteriovenous grafts.

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“…Despite of having reported low incidence of CVI, steal syndrome is a major concern as well. Grandman and collaborators 5,16 reported 8 cases of steal syndrome in a series of 25 patients, including a case of amputation due to compartmental syndrome.…”

Section: Discussionmentioning

confidence: 99%

Latero-lateral femoro-femoral arteriovenous fistula: a new surgical approach for hemodialysis patients with no vascular access

et al. 2011

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Purpose: A new surgical approach for vascular access for hemodialysis using a latero-lateral arteriovenous fistula (AVF) in the thigh between the femoral artery (FA) and superficial femoral vein (SFV) transposed to the subcutaneous layer in patients with no other access options is described. Methods: Ten patients (mean age: 37,9 years) for whom all possible sites for execution of any other procedure had been exhausted, underwent latero-lateral AVF close to the adductor channel between the FA and the SFV. The FSV was released and sectioned 2 cm from its confluence with the deep femoral vein and transposed in the subcutaneous tissue with extensions using saphenous vein or prosthetic material (PTFE) when needed. Follow -up included patency, flow evaluation and complications. Results: Postoperative follow-up ranged from 3 to 96 months, with a mean of 38 months. The AVFs presented a flow of more than 350 ml/min and the AVFs remained patent for a mean period of 38 months. There were three failures of the procedures at 3, 5 and 7 months during postoperative follow-up due to graft infection and thrombosis (a case), anaphylactic shock and thrombosis (a case) and calf pain during dialysis (a case). Two patients developed slight inferior limb edema. Conclusion: The new surgical approach for access for hemodialysis represents a feasible procedure, with acceptable patency rates in exceptional cases where no other access option is available. Key words: Arteriovenous Fistula. Femoral Vein. Femoral Artery. Renal Dialysis. RESUMOObjetivo: Nova abordagem para acesso vascular para hemodiálise usando fistula artério-venosa (FAV) látero-lateral na coxa entre a artéria femoral (AF) e a veia femoral superficial (VFS) transposta no subcutâneo em pacientes sem opção de acesso. Métodos: Dez pacientes (idade média 37,9 anos), cuja possibilidade de acesso havia sido exaurido, foram submetidos a FAV látero-lateral na coxa entre a AF e a VFS.Esta veia foi liberada e seccionada 2 cm de sua confluência com a veia femoral profunda e transposta no plano superficial com extensão usando a veia safena ou material protético (PTFE) quando necessário.O seguimento incluíu a perviedade , fluxo e complicações. Resultados: O seguimento pós-operatório foi de 3 a 96 meses (média 38). A FAV apresentou fluxo mínimo de 350 ml/min e permaneceu pérvia no período médio de 38 meses. Houve 3 falências aos 3, 5, e 7 meses pós-operatórios por infecção de prótese e trombose da FAV (um caso), choque anafilático e trombose (um caso) e dor na panturrilha na hemodiálise (um caso). Dois pacientes desenvolveram discreto edema de membro inferior. Conclusão: A nova abordagem para acesso vascular para hemodiálise representa um procedimento factível, com aceitável perviedade em casos excepcionais onde nenhum outro acesso é disponível. Descritores: Fístula Arteriovenosa. Veia Femoral. Artéria Femoral. Diálise Renal. Latero-lateral femoro-femoral arteriovenous fistula. A new surgical approach for hemodialysis patients with no vascular access

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Femoral vein transposition for arteriovenous hemodialysis access: Improved patient selection and intraoperative measures reduce postoperative ischemia

Cited by 92 publications

References 18 publications

Lower Extremity Permanent Dialysis Vascular Access

Lower Extremity Permanent Dialysis Vascular Access

Percutaneous transluminal angioplasty for dysfunctional femoral hemodialysis graft

Latero-lateral femoro-femoral arteriovenous fistula: a new surgical approach for hemodialysis patients with no vascular access

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