title: Arm composite autogenous vascular access using the great saphenous vein and the femoral vein: results from a single-centre study.
abstract: OBJECTIVE
  The objective is to report our results with the arm composite autogenous vascular access (ACAVA) using the great saphenous vein (GSV) and the femoral vein (FV) in tertiary vascular access surgery.
  
  
  METHODS
  Retrospective single-centre study. Prospectively collected clinical database.
  
  
  METHODS
  Between August 2009 and March 2011, 17 patients with no suitable upper extremity vein, repeated prosthetic access failure and/or infection underwent the construction of an ACAVA. Outcome measures included the graft patency and complication rates.
  
  
  RESULTS
  The median follow-up was 25 months (5-32). Thirty-day morbidity affected 10 patients (59%): four wound-healing issues, three lower limb swelling, two early thromboses and one upper limb haematoma. No postoperative death occurred. At 3 months, the primary patency rate was 88% ± 8%. At 6 months, the assisted-primary patency rate was 82.4% ± 9.2%. At 12 months, the secondary patency rate was 81.6% ± 9.6%. Twenty-four secondary interventions were performed. Steal syndrome occurred in one patient following a secondary procedure. Swelling of the lower limb remained in two patients at the end of their follow-up. Three ACAVAs developed irreversible occlusion leading to loss of access.
  
  
  CONCLUSIONS
  With a high rate of postoperative morbidity and re-intervention, the ACAVA is a useful additional technique that should be restricted to difficult cases with limited vascular access options.
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France.
authors.forename: N
authors.initials: N
authors.lastname: Sadaghianloo
authors.forename: E
authors.initials: E
authors.lastname: Jean-Baptiste
authors.forename: A
authors.initials: A
authors.lastname: Mousnier
authors.forename: S
authors.initials: S
authors.lastname: Declemy
authors.forename: R
authors.initials: R
authors.lastname: Hassen-Khodja
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005268:Femoral Vein / Q000503:physiopathology / Q000637:transplantation*; D005602:France; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D006435:Renal Dialysis; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014945:Wound Healing