RESEARCH ARTICLE Open Access
Saphenofemoral arteriovenous fistula ashemodialysis access
João A Correa
, Luiz Carlos de Abreu
, Adilson C Pires
, João R Breda
, Yumiko R Yamazaki
, Alexandre C Fioretti
,Vitor E Valenti
, Luiz Carlos M Vanderlei
, Hugo Macedo Junior
, Eduardo Colombari
, Fausto Miranda Junior
An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There havebeen few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestionsof poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF.
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 needlingand complications associated to its use.
Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10transplanted (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 successfullythrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the firstpostoperative day. 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 upperlimbs, allowing efficient dialysis with good long-term patency with a low complication rate.
The establishment of vascular access for hemodialysis(HD) remains a challenge for vascular surgery. Due tothe improvement of chronic renal failure treatment andconsequently, increased survival, maintenance of vascu-lar access and long-term treatment of its complications,it has become an important cause of hospitalization,morbidity and patient costs [1,2].
The access of choice for HD is a primary arteriove-nous (AV) fistula in the upper limb, between the radialartery and the cephalic vein [3-6]. This technique
increases venous flow approximately 250-300 ml perminute, which is the minimum flow velocity needed toobtain the appropriate clearance of urea after 4 hours of HD. The preference for its use is due to the longer per-iod of working of these AV communications, low rate of complications and easy handling [7-9]. Prolonged use of
these accesses may lead to complications such asinfection, puncture pseudoaneurysm, anastomotic pseu-doaneurysm, venous hypertension, distal ischemia andtheir own obstruction . In this situation, generally creation of new AV fistula is indicated.Some disadvantages of using AV fistula by transposi-tion of the femoral vein are the necessity for a moreextensive and deeper dissection that uses larger vesselsand make it more susceptible to infection and steal syn-drome. Such problems were also observed by us and motivated us to seek a new alternative techni-que, using a saphenous vein in
; conformation,anastomosed to the superficial femoral artery near theadductor canal . The initial benefits of this proce-dure encouraged us to expand the study with a largerpatient number, analyzing the results of clinical experi-ence and late complications. Therefore, in view of theabove considerations, we aimed to evaluate the resultsof saphenofemoral AV fistula (SFAVF) as access to HD.
This is a longitudinal prospective study conducted at theHospital of the Faculdade de Medicina do ABC, in São
Departamento de Cirugia da Faculdade de Medicina do ABC, Santo André,SP, BrasilFull list of author information is available at the end of the article
© 2010 Correa et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.