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Saphenofemoral arteriovenous fistula as hemodialysis access.

Correa JA, de Abreu LC, Pires AC, Breda JR, Yamazaki YR, Fioretti AC, Valenti VE, Vanderlei LC, Macedo H, Colombari E, Miranda F - BMC Surg (2010)

Bottom Line: Here, we describe our clinical experience with SFAVF.After 59 months of follow-up, primary patency was 44%.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departamento de Cirugia da Faculdade de Medicina do ABC, Santo André, SP, Brasil. cor.jantonio@gmail.com

ABSTRACT

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%.

Conclusion: 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.

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Related in: MedlinePlus

Patient positioned for surgery with demarcation of the planning technique.
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Figure 1: Patient positioned for surgery with demarcation of the planning technique.

Mentions: Patients were submitted to SFAVF creation according to the following standardization: (1) Election of the most suitable limb for manufacture of AV fistula through clinical examination based on arterial and venous conditions: presence of normal peripheral pulses and no signs of chronic venous hypertension or varicose vein disease. (2) Patient on horizontal dorsal supine position under spinal anesthesia. (3) Antisepsis with iodopovidine and delimitation of the surgical area with sterile cloths (Figure 1). (4) Longitudinal incision of approximately 6 cm in the inguinal region, dissection and ligation of tributary veins of the proximal saphenous vein. (5) Stab incisions for dissection of the saphenous vein to its distal third of the thigh (Figure 2). (6) Oblique incision of approximately 10 cm in the middle third of the distal inner thigh. (7) Dissection of the distal thigh followed by planes of dissection and isolation of the superficial femoral artery above the hiatus of the adductor magnus medially away from the sartorius muscle (Figure 3). (8) Distal ligation, removal of the bed with plastic tube catheterization number six and heparinization of the saphenous vein with 20 ml of heparin 1% (Figure 4). (9) Production of subcutaneous tunnel by blunt dissection in the anterolateral thigh in order to place the saphenous vein in front of its new bed. (10) Proximal and distal superficial femoral artery clamp and longitudinal arteriotomy of approximately 1 cm. (11) Proximal heparinization with 10 ml of heparin to 1%, end-to-side saphenous vein to the femoral artery, using running sutures of 6-0 polypropylene. (12) Arterial and venous unclamp according to maneuvers and pulmonary embolic protection. (13) Passage of the saphenous vein through the subcutaneous tunnel (Figure 5). (14) Verification of the final terms, as the conformation of the vein and the thrill of the proximal and distal AV fistula. Figure 6 represents the anastomosis between the saphenous vein and superficial femoral artery and Figure 7 presents the final aspect of the surgical scars.


Saphenofemoral arteriovenous fistula as hemodialysis access.

Correa JA, de Abreu LC, Pires AC, Breda JR, Yamazaki YR, Fioretti AC, Valenti VE, Vanderlei LC, Macedo H, Colombari E, Miranda F - BMC Surg (2010)

Patient positioned for surgery with demarcation of the planning technique.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2965703&req=5

Figure 1: Patient positioned for surgery with demarcation of the planning technique.
Mentions: Patients were submitted to SFAVF creation according to the following standardization: (1) Election of the most suitable limb for manufacture of AV fistula through clinical examination based on arterial and venous conditions: presence of normal peripheral pulses and no signs of chronic venous hypertension or varicose vein disease. (2) Patient on horizontal dorsal supine position under spinal anesthesia. (3) Antisepsis with iodopovidine and delimitation of the surgical area with sterile cloths (Figure 1). (4) Longitudinal incision of approximately 6 cm in the inguinal region, dissection and ligation of tributary veins of the proximal saphenous vein. (5) Stab incisions for dissection of the saphenous vein to its distal third of the thigh (Figure 2). (6) Oblique incision of approximately 10 cm in the middle third of the distal inner thigh. (7) Dissection of the distal thigh followed by planes of dissection and isolation of the superficial femoral artery above the hiatus of the adductor magnus medially away from the sartorius muscle (Figure 3). (8) Distal ligation, removal of the bed with plastic tube catheterization number six and heparinization of the saphenous vein with 20 ml of heparin 1% (Figure 4). (9) Production of subcutaneous tunnel by blunt dissection in the anterolateral thigh in order to place the saphenous vein in front of its new bed. (10) Proximal and distal superficial femoral artery clamp and longitudinal arteriotomy of approximately 1 cm. (11) Proximal heparinization with 10 ml of heparin to 1%, end-to-side saphenous vein to the femoral artery, using running sutures of 6-0 polypropylene. (12) Arterial and venous unclamp according to maneuvers and pulmonary embolic protection. (13) Passage of the saphenous vein through the subcutaneous tunnel (Figure 5). (14) Verification of the final terms, as the conformation of the vein and the thrill of the proximal and distal AV fistula. Figure 6 represents the anastomosis between the saphenous vein and superficial femoral artery and Figure 7 presents the final aspect of the surgical scars.

Bottom Line: Here, we describe our clinical experience with SFAVF.After 59 months of follow-up, primary patency was 44%.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departamento de Cirugia da Faculdade de Medicina do ABC, Santo André, SP, Brasil. cor.jantonio@gmail.com

ABSTRACT

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%.

Conclusion: 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.

Show MeSH
Related in: MedlinePlus