Long-term outcomes of transposed femoral vein arteriovenous fistula for abandoned upper extremity dialysis access.

Autor:	Orion KC; Division of Vascular Diseases and Surgery, Department of Surgery, Ohio State University School of Medicine, Columbus, Ohio. Electronic address: kristine.orion@osumc.edu., Kim TI; Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn., Rizzo AN 2nd; Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio., Cardella JA; Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn., Rizzo A Sr; Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio., Sarac TP; Division of Vascular Diseases and Surgery, Department of Surgery, Ohio State University School of Medicine, Columbus, Ohio.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2021 Jul; Vol. 74 (1), pp. 225-229. Date of Electronic Publication: 2021 Mar 03.
DOI:	10.1016/j.jvs.2020.12.065
Abstrakt:	Background: The number and longevity of patients with end-stage renal disease requiring dialysis access have continued to increase, leading to challenging situations, including exhausted upper extremity access and severe central venous stenosis. This has led to an increase in the use of alternative access sites, including the lower extremities. The transposed femoral vein arteriovenous fistula for dialysis access is a previously described alternative, although limited data are available on its long-term patency. Methods: Patients treated with a transposed femoral vein fistula were retrospectively reviewed. A transposed femoral vein fistula was created by harvesting the femoral vein and transposing it to the distal superficial femoral artery at the level of the adductor canal. The demographic information, perioperative characteristics, complications, and long-term outcomes were recorded and analyzed. Results: A total of 21 patients had undergone transposed femoral vein fistula for dialysis access after an average of 5.3 ± 2.8 failed dialysis access procedures and a duration of 6.1 ± 4.9 years from the initiation of dialysis. The average age at the procedure was 53.5 ± 12.8 years. Ten patients (47.6%) had a history of diabetes mellitus and nine (42.9%) had a history of coronary artery disease. Technical success was achieved in 100% of cases, and 16 patients (76.2%) were discharged with anticoagulation therapy. The primary patency at 1, 3, and 5 years was 93%, 74%, and 74%, respectively. The secondary patency at 1, 3, and 5 years was 100%, 89%, and 89%, respectively. Two patients had compartment syndrome requiring fasciotomy, and six patients experienced wound complications. Conclusions: Transposed femoral vein fistula for dialysis access is a viable alternative for patients with an exhausted upper extremity access, with good long-term patency. (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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