Saphenofemoral arteriovenous fistula as hemodialysis access

Abstract

BackgroundAn upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF.MethodsSFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use.ResultsFifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%.ConclusionSFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.

Tagliatelle technique for arteriovenous fistula creation using a great saphenous vein semipanel graft

“…The largest series of GSV access has reported a 30-day access loss rate of 21 from 56 fistulas (37.5%) with 20 cases as a result of access thrombosis. 2 Pierre-Paul et al reported similar findings with a primary patency of only 7 months and an average of three balloon percutaneous transluminal angioplasties per patient. In addition to two operated pseudoaneurysms, only five of seven fistulas had been successfully used for dialysis, and all patients developed vein loop stenosis.…”

“…Few reports exist on the utilization of the great saphenous vein (GSV) for vascular access with poor results. 1,2 Most surgeons today utilize prosthetic grafts or transposition of the femoral vein (tFV) for lower limb access. 3 In this report, we describe an optimized technique for GSV reconstruction in order to serve as a dialysis conduit.…”

Comparing frozen saphenous vein with Gore‐tex in vascular access for chronic hemodialysis

“…At the end of the follow‐up period, the flow rates of all fistulas were measured by Doppler sonography and by its base. They were grouped as good (> 300 mL/min), moderate (100–300 mL/min), and poor (< 100 mL/min) . All patients were dialyzed by their shunts in the follow‐up period by the same dialyzers.…”

“…They were grouped as good (> 300 mL/min), moderate (100-300 mL/min), and poor (< 100 mL/min). 8 All patients were dialyzed by their shunts in the follow-up period by the same dialyzers. Number 14 dialysis needle was used for venipuncture and the mean duration of each procedure was 4 hours.…”

Vascular Access for Hemodialysis - Overview and Emphasis on Complications

“…It is created by anastomosis of the distal femoral artery and the great saphenous vein ( Figure 11) which is subcutanously transposed to allow cannulation. Access survival is acceptable [41].…”