title: Arteriovenous fistula construction using femoral vein in the thigh and upper extremity: single-center experience.
abstract: The objective of this study was to determine the outcome of femoral vein (FV) access as either a FV thigh transposition or upper extremity FV translocation. This is a retrospective review of all end-stage renal disease (ESRD) patients who underwent FV access at the University of Colorado Health Sciences Center from December 2004 to May 2007. Demographics, number of prior access procedures, FV dialysis access procedure, periprocedural complications, mean follow-up, secondary access-related procedures, and access function were recorded. Complications were subdivided into FV harvest site- and ischemia-related. Nineteen patients underwent FV access during the study period: 10 underwent FV thigh transpositions and nine underwent upper extremity FV translocations. The median number of prior access procedures was two. The median hospital stay was 3 days, and there were no perioperative deaths. Eight patients had FV harvest site complications: six lymphoceles, one AVF infection requiring ligation, and one compartment syndrome requiring fasciotomy. Three (16%) patients had ischemic complications: one required ligation of the AVF and two required distal revascularization interval ligation. Seventy-nine percent of patients had a functioning access at a mean follow-up of 6 months (range 23 days to 3 years). Four FV arteriovenous accesses required one or more endovascular procedures to maintain function at 12 months. The use of FV access in ESRD is durable at intermediate follow-up but has significant morbidity. FV access should be reserved for good-risk patients who have exhausted other autogenous options.
authors.affiliation: University of Colorado Health Sciences Center, Department of Surgery, Division of Vascular Surgery Denver, CO 80045, USA. Carlos.rueda@uchsc.edu
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Rueda
authors.forename: Mark R
authors.initials: MR
authors.lastname: Nehler
authors.forename: Traci A
authors.initials: TA
authors.lastname: Kimball
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Dimond
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Whitehill
authors.forename: Brian D
authors.initials: BD
authors.lastname: Peyton
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001367:Axillary Vein / Q000503:physiopathology / Q000601:surgery*; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery*; D005268:Femoral Vein / Q000503:physiopathology / Q000637:transplantation*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency