The transposed femoral vein arteriovenous fistula for hemodialysis

Abstract

Introduction: The prevalence and incidence of patients in need of hemodialysis worldwide are increasing. The population in need of hemodialysis is becoming older and vascular comorbidities are more frequent than decades ago. Consequently, the prevalence of patients with exhausted possibilities of upper limb vascular accesses increases. In contrast to other lower limb vascular accesses, a fistula by transposing the femoral vein to the superficial femoral artery promises better patency rates in preliminary series. Methods: The first seven cases performed between October 2015 and March 2017 at the only center in Denmark performing this procedure were reviewed regarding demographics, comorbidities, complications, and patency. Results: The study population consisted of five males and two females, with a mean age of 61.6 ± 9.9 years, mean body mass index 24.9 ± 2.6, with various causes of uremia. Five patients (71.4%) experienced at least one complication, such as wound dehiscence, lymphocele, infection, hematoma, or steal. First cannulation of the transposing the femoral vein to the superficial femoral artery was conducted after 12.2 ± 4.3 weeks. Postoperatively, the patients have been followed 16.4 ± 9.6 months in the dialysis center. All but one is still using their transposing the femoral vein to the superficial femoral artery for dialysis, but three of these needed revision to maintain patency giving a primary and primary-assisted patency of 42.9 (95% confidence interval: 15.8–75.0) and 85.7 (95% confidence interval: 48.7–97.4), respectively. Conclusion: Although postoperative complications and need for revision to maintain patency persists, our experience suggests that this is a feasible method when it is no longer possible to create an upper extremity vascular access. A learning curve for the entire vascular access team must be expected.