Endoscopic saphenous vein harvesting for hemodialysis vascular access creation in the forearm: A new approach for arteriovenous bridge graft.
When superficial arm veins are not suitable to create a native arteriovenous (AV) fistula, an arterio-venous bridge graft by native and/or prosthetic graft is the next best alternative. However, harvesting a native vein, such as the saphenous vein (SV), is invasive and requires a large incision. We report an endoscopic saphenous vein harvesting (ESVH) technique combined with forearm bridge grafting as a new approach for vascular access (VA).


METHODS
We used the Clearglide, Endoscopic Vessel Harvesting System (Eticon, Inc.) for a less invasive SV harvesting technique. Five patients had a SV graft implant and 10 patients had a polytetrafluoroethylene (PTFE) graft implant in the forearm.


RESULTS
The SV was harvested easily in all patients in 46 +/- 2 min. There were no wound complications. All SV and PTFE grafts provided satisfactory access within 1 month; however, two declotting procedures in the SV group and five in the PTFE group were required. The PTFE group had two graft infections.


CONCLUSIONS
It is possible that a combination of ESVH and SV forearm grafting will be one of the new approaches for hemodialysis (HD) access.
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Department of Cancer and Thoracic Surgery, Okayama University School of Medicine, Okayama - Japan.