High-output Congestive Failure From Femoral Arteriovenous Shunts for Vascular Access

Fee, Henry J.; Levisman, Jorge A.; Doud, Robert B.; Golding, Arthur

doi:10.1097/00000658-197603000-00019

Cited by 22 publications

(8 citation statements)

References 2 publications

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“…Jackson and colleagues 6 reported that the superficial femoral vein is an ideal material for vascular access in the lower extremities. However, complications are frequent including thromboses, cardiac failure, symptomatic distal leg ischemia (steal syndrome), aneurysm, edema of the limb and infection 14,15 . Despite of having reported low incidence of CVI, steal syndrome is a major concern as well.…”

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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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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“…However, the follow-up period is short, and we cannot be sure that such large A-V fistulas will not induce deleterious hemodynamic disturbances in the long run. Indeed, Fee et al [10] have reported a case of high output congestive heart failure due to a SVLF 3 years after its creation.…”

Section: Discussionmentioning

confidence: 99%

Saphenous vein loop fistula in the thigh for maintenance hemodialysis

et al. 1979

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Thirty patients with 31 saphenous vein loop fistulas (SVLF) constructed in the thigh were followed up for 1-31 months. The predicted patency rates for these blood access devices were 75% at 1 year and 43% at 2 years. For 277 patients with direct arteriovenous (A-V) fistulas located in the forearm (FF), these percentages were 85% and 83%, respectively. There were several differences between the 2 groups, including a higher percentage (84%) of women in the SVLF group than in the FF group (39%, p < 0.0005). In addition, 19% of SVLF patients had polycystic kidney disease, while only 10% of the FF patients suffered from this disease. The incidence of false aneurysms was significantly higher with SVLF (16%) than with FF (2%, p < 0.0005).

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“…It is the opinion of many that as long as there is significant cardiac reserve; symptoms of CF do not develop. However, postfistula placement, if this high CO cannot be maintained due to the presence of underlying stressors (like ischemia) or if additional stressors like anemia develop such that the already high CO cannot increase further, CF is precipitated . The development of HOCF appears to be inversely related to the distance between the heart and the site of the AVF atleast in the upper limb.…”

Section: High Output Cardiac Failurementioning

confidence: 99%

Complications of a High‐flow Access and Its Management

Sequeira

Tan

2015

Seminars in Dialysis

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A high-flow access has been defined as one with a flow >1-1.5 l/minute or as one where the access flow is >20% of the cardiac output. Although it may be asymptomatic, it can be associated with cardiopulmonary complications, aneurysms, central vein stenosis and the distal hypoperfusion ischemic syndrome in some patients. The decision for surgical intervention should be made after careful medical optimization especially in patients with high output cardiopulmonary compromise. In this review, we present a summary of current knowledge about the pathophysiology of a high-flow fistula, followed by a concise, comprehensive synopsis of current medical and surgical therapy.

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High-output Congestive Failure From Femoral Arteriovenous Shunts for Vascular Access

Cited by 22 publications

References 2 publications

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

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

Saphenous vein loop fistula in the thigh for maintenance hemodialysis

Complications of a High‐flow Access and Its Management

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