Subcutaneous transposition of the superficial femoral artery for arterioarterial hemodialysis: technique and results.
We report the use of subcutaneous transposition of the femoral artery (STFA) for placement of both inflow and outflow needles in 14 hemodialysis (HD) adult patients with difficult access. Follow-up time was 318 months during which a total of 3215 arterioarterial HD sessions were done. Kt/V values ranged between 0.71 and 1.59. Elevated access recirculation and dialysis outflow pressures were common findings to all patients. Complications were: (i) two episodes of bleeding secondary to puncture-related arterial wall laceration, repaired by stitching; (ii) three episodes of thrombosis in two patients, all successfully declotted; (iii) three puncture-related complications needing placement of a vein interposition graft, namely, aneurysm, pseudoaneurysm, and arterial stenosis; and (iv) one case of arterial ligation because of suppurative puncture site infection, without subsequent distal ischemia signs or claudication. The use of STFA should only be reserved for patients in urgent need for vascular access with no remaining options.
Salgado
Octavio J
OJ
Center of Experimental Surgery and Medicine, University of Zulia, Maracaibo, Venezuela. ojsalg@hotmail.com
Terán
Nemesio A
NA
Rosales
Beatriz
B
Garcia
Rafael A
RA
D000328:Adult; D000783:Aneurysm / Q000209:etiology; D017541:Aneurysm, False / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis / Q000379:methods*; D013927:Thrombosis / Q000209:etiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult