Clinical experience with the saphena loop arteriovenous fistula on the thigh

The increasing number of patients on regular dialysis treatment (RDT) for many years produces a number of problems, one of which is the vascular access procedure. When the internal subcutaneous fistula cannot be used either as the first procedure or after some years of treatment, alternative methods are necessary. We present here clinical experience with the saphenous vein arteriovenous fistula placed on the upper thigh in 8 patients. The function was insufficient with a flow rate of about 125 ml/min and the complication rate was very high with development of 5 haematomas, 1 thrombosis and 1 case of severe oedema. Far more serious, however, the recording of 2 fatal external bleeding episodes. According to the literature, clinical experience with this procedure is very limited in other centres. From our experience we would not recommend this procedure and from the 2 fatal bleeding episodes we would question the placement of any fistula on the upper thigh unless absolutely necessary.