Lower-extremity saphenous vein transposition arteriovenous fistula: an alternative for hemodialysis access in AIDS patients.
Arteriovenous access for long-term hemodialysis in patients with the acquired immunodeficiency syndrome (AIDS) represents a special challenge. Many of these patients are chronic intravenous drug abusers and do not have patent superficial upper-extremity veins available for conventional arteriovenous fistulas. This group of patients is also particularly prone to infections, which contraindicates the use of prosthetic grafts. Over a period of 13 months, five lower-extremity saphenous vein transposition arteriovenous fistulas (SVTAFs) were performed. Four patients had a diagnosis of AIDS at the time of operation; all of these were intravenous drug abusers. Three patients were male, two were female, and their age ranged from 34 to 66 years (mean, 48). Three patients had a SVTAF as their first hemodialysis access, and in two it was performed after multiple failed upper-extremity accesses. Four fistulas remain patent to date, after a mean follow-up of 11 months (range, 4 weeks to 16 months). One fistula thrombosed 4 weeks postoperatively, due to a hematoma that occurred after premature venipuncture for dialysis. There were no other major complications. We conclude that SVTAF is a suitable alternative to the limited hemodialysis venous access sites, especially in the AIDS population.
Gorski
T F
TF
Department of Surgery, Brooklyn Hospital Center, New York, USA.
Nguyen
H Q
HQ
Gorski
Y C
YC
Chung
H J
HJ
Jamal
A
A
Muney
J
J
D016263:AIDS-Associated Nephropathy / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002481:Cellulitis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000601:surgery*; D015819:Substance Abuse, Intravenous / Q000150:complications; D013927:Thrombosis / Q000209:etiology