Femoral Vein Transposition Arteriovenous Fistula is a Feasible Option in "Selected" Patients as Hemodialysis Access

Abstract

Introduction: Lower extremity hemodialysis access is offered to the patients who have severe central venous stenosis. Femoral vein transposition arteriovenous fistula (FV tAVF) is an alternative to lower leg arteriovenous prosthetic grafts. Its safety and patency is under observation. Materials and Methods: This is a retrospective review of patients who had FV tAVF between January 2011 and March 2016. Preoperative clinical findings, intraoperative findings, postoperative complications, and patency of the AVF were noted and analyzed. Results: There were 7 patients who underwent FV tAVF during this study period. Most patients were female (6 : 1), with mean age of 45.2 years (range, 33-55 years). All patients were hypertensive. Mean body mass index was 26.1 kg/m². Patient had on average previous 6 dialysis accesses. Most patients had preoperative venograms (6/7). Mean interval between initiation of dialysis and creation of the arteriovenous fistula was 1.08 years. All procedures were done under general anesthesia. Four patients required extension of FV with either the small segment of polytetrafluorethylene or vein graft. Two patients had early postoperative complications. One patient developed hematoma, whereas other had wound dehiscence. All the accesses were utilized for dialysis after a mean interval of 6 weeks. All patients had a patent fistula on average follow-up of 2 years. Conclusion: Appropriate patient selection for FV tAVF can provide good patency with low incidence of complications. This can be considered for good risk individuals undergoing their first lower extremity access.

Keywords: arteriovenous access; hemodialysis; lower extremity.