title: Adjunctive use of the superficial femoral vein for vascular reconstructions.
abstract: OBJECTIVE
  Although the superficial femoral vein (SFV) is an accepted treatment for aortic graft infections, this conduit also has potential uses in other areas. Herein, we evaluate our experience using the SFV for arterial and venous bypasses and the arteriovenous (AV) fistula for dialysis access.
  
  
  METHODS
  Between 1999 and 2011, 42 patients underwent a bypass or a thigh AV fistula using the SFV (31 arterial, four central venous, six AV fistulas, and one common carotid-to-vertebral bypass). Indications for arterial bypass included infected graft (20), critical limb ischemia (nine), and failed bypass (six). Indications for central venous bypass were: superior vena cava syndrome (two), vessel reconstruction due to tumor encasement (one), and central vein occlusion from thoracic outlet syndrome (one). All AV fistulas were created after patients sustained bilateral subclavian vein occlusions from failed upper extremity access. The common carotid-to-vertebral bypass was created due to an occluded vertebral artery with resultant stroke.
  
  
  RESULTS
  Kaplan-Meier cumulative patency curves were used. The primary patency rates at 30 days, 1 year, and 3 years were 97.4% (95% confidence interval [CI], 92.41-100), 74.6% (95% CI, 57.89-96.23), and 66.4% (95% CI, 47.06-93.53), respectively. The assisted primary patency rates at 30 days, 1 year, and 3 years were 100% (95% CI, 100-100), 97.1% (95% CI, 91.54-100), and 89% (95% CI, 74.29-100), respectively. Secondary patency rates at 30 days, 1 year, and 3 years were 100% (95% CI, 100-100), 97.1% (95% CI, 91.54-100), and 89% (95% CI, 74.29-100), respectively. Limb salvage rates at 30 days, 1 year, and 3 years were 97.3% (95% CI, 92.21-100), 93.6% (95% CI, 78.35-100), and 93.6% (95% CI, 78.35-100), respectively. Survival rates at 30 days, 1 year, and 3 years were 97.6% (95% CI, 92.95-100), 86% (95% CI, 75.3-98.3), and 86% (95% CI, 75.3-98.3), respectively. Follow-up ranged from 1 month to 8.7 years (mean time, 21 months). Complications occurred in 22 patients (52%) and included wound complications (n = 19; 45.2%); deep vein thrombosis (n = 1; 2.4%); anastomotic breakdown (n = 1; 2.4%); hematoma (n = 4; 9.5%); pulmonary embolism (n = 2; 4.8%); and compartment syndrome (n = 2; 4.8%).
  
  
  CONCLUSIONS
  The SFV is a durable conduit for uses beyond aortic reconstruction and should be considered when the great saphenous vein is not available or size match is a concern. However, wound complications remain a problem.
authors.affiliation: Department of Vascular Surgery, The Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA.
authors.forename: Soma
authors.initials: S
authors.lastname: Brahmanandam
authors.forename: Daniel
authors.initials: D
authors.lastname: Clair
authors.forename: James
authors.initials: J
authors.lastname: Bena
authors.forename: Timur
authors.initials: T
authors.lastname: Sarac
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D055499:Catheter-Related Infections / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000601:surgery; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011183:Postoperative Complications / Q000209:etiology; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D013479:Superior Vena Cava Syndrome / Q000601:surgery; D013901:Thoracic Outlet Syndrome / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects