Femoral Vein transposition: a viable option for dialysis
Emilia Krol1, Juliet Blakeslee - Carter1, David J. Dexter, M.D.1, Gordon Stokes1, Jean Panneton2.
1EVMS, Norfolk, VA, USA, 2Jean Panneton, Norfolk, VA, USA.
OBJECTIVES: Dialysis access in patients who have exhausted upper extremity options is a surgical challenge. Lower limb access is frequently utilized in patients with poor dialysis access options The NKF-DOQI guidelines do not differentiate lower extremity options due to a lack of scientific evidence. We present our data on a single center experience with femoral vein transposition (FVT) for dialysis access METHODS: We performed a retrospective review of all patients who underwent femoral vein transposition between January 2010 and July 2017. We included all patients who had any variant of femoral vein transposition. Patients with saphenous vein transpositions and non-autologous grafts without the use of femoral vein were excluded from study. Primary endpoints evaluated were primary fistula access and primary patency of the circuit. Statistical analysis was carried out using SPSS (IBM Armonk, NY). RESULTS: We identified 22 patients who underwent FVT in our study period. Average length of follow up was 13.5 months. We utilized several different technique variants of FVT creation. Femoral vein (FV) was used as the only conduit in 7 patients. When femoral vein was too short to be used as a single segment a ProCol (LeMaitre Burlington, MA) extension was used in 2 patients and a saphenous vein (GSV) extension was used in another 13 patients. A femoral-femoral loop configuration was created in 11 patients and a popliteal-femoral straight configuration was created in 11 patients. Average time to cannulation was 2 months. Kaplan - Meyer analysis showed no difference in primary and primary assisted patency between FV, FV + GSV, and FV + ProCol group. Within the femoral vein conduit group 2 patients (29%) lost primary patency, compared to 7 patients who received saphenous and femoral vein conduit (54%. We identified 17 patients who had at least 6 months of follow up. At 6 months 13/17 (65%) of patients maintained primary patency and 15/17 (88%) of fistulas were functional
CONCLUSIONS: Femoral vein transposition is a viable option for patients with inadequate upper extremity access. The use of saphenous vein as adjunct conduit was associated with lower patency rates. FVT provides a good short and long term access options for patients without appropriate upper extremity dialysis access options
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