Saphenofemoral arteriovenous fistula as hemodialysis access.
BACKGROUND
An 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.


METHODS
SFAVFs 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.


RESULTS
Fifty-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%.


CONCLUSIONS
SFAVF 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.
Departamento de Cirugia da Faculdade de Medicina do ABC, Santo André, SP, Brasil. cor.jantonio@gmail.com
João A
JA
Correa
Luiz Carlos
LC
de Abreu
Adilson C
AC
Pires
João R
JR
Breda
Yumiko R
YR
Yamazaki
Alexandre C
AC
Fioretti
Vitor E
VE
Valenti
Luiz Carlos M
LC
Vanderlei
Hugo
H
Macedo
Eduardo
E
Colombari
Fausto
F
Miranda
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012501:Saphenous Vein / Q000601:surgery*