Vascular access for chronic dialysis using the superficial femoral vein

We report our experience in using the superficial femoral vein to create hemodialysis (HD) arteriovenous (AV) fistulas. Surgery was performed on six patients (four female, two male). Indications for surgery included previous fistula loss, graft infection and exhaustion of typical shunt sites.

The femoral vein was evaluated preoperatively, by Doppler ultrasound, harvested by one long incision on the anteromedial surface of the thigh, followed by suction drainage. In four patients, harvested veins were transplanted in the arm between the brachial artery and axillar vein, followed by an end-to-side anastomosis. In two patients, the venous graft remained on the anterior surface of the thigh. In those patients, they were extended with either a piece of polytetrafluoroethylene (PTFE) graft or the saphenous vein.

Follow-up ranged between 14 months and 2 yrs, ensuring proper dialysis. Two patients presented with complications, including lower leg swelling and axillary lymphorrhea, which subsided spontaneously.

We recommend this type of AV fistula, especially in difficult cases, where all other classical vascular approaches have been used. However, the procedure is time consuming and requires experience in vascular surgery.