November 04, 2009

Translocation of the Femoropopliteal Vein for Autogenous Arteriovenous Fistula Creation: Excellent Patency but High Incidence of Wound Complications and Steal Syndrome

Malachi G. Sheahan, MD, Hernan Bazan, MD, Claudie Sheahan, MD, Bruce Torrance, MD, Addison Thompson, MD, Tapash Palit, MD, Robert Batson, MD, Larry Hollier, MD, Paul Perkowski, MD, Jon Schellack, MD.
Louisiana State University Health Sciences Center, New Orleans, LA, USA.

Objectives: This study was performed to evaluate the use of femoralpopliteal vein conduit in hemodialysis patients who have either exhausted conventional arteriovenous fistula (AVF) constructions or who were not candidates for autogenous AVF formation using upper extremity veins.
Methods: This is a retrospective review of all patients who underwent construction of an autogenous AVF using the femoropopliteal vein over a three year period. All patients underwent preoperative venous evaluation with either duplex ultrasound and/or venography. Inclusion criteria included inadequate upper extremity veins for autogenous AVF creation (<15 mm).
Results: Over a three year period (2003 - 2006), 31 patients underwent AVF creation using the femoropopliteal vein in either the upper extremity (n=26) or the lower extremity (n=5). Mean age was 55 years and 61% were female (19/31). There were no perioperative deaths. Steal syndrome occurred in 16% (5/31), requiring a distal revascularization and interval ligation in 4 patients. No patient required amputation. Wound complications occurred in 65% (20/31), including seroma (6%, 2/31), wound dehiscence (19%, 6/31), lymphocele formation (45%, 14/31), hematoma (48%, 15/31), and infection (48%, 15/31) Lower extremity edema occurred in 42% (13/31) postoperatively. Six and twelve month primary patency rates were 68.2%±9.3% and 64%±9.6% respectively. Primary assisted patency at 6 and 12 months was 96.1%±3.9% and 88%±6.5%, while secondary patency was 100% and 95.8%±4.1%.
Conclusions: Using the superficial femoropopliteal vein in constructing autogenous AVF is a valid option for surgeons facing a difficult dialysis access patient as it results in excellent patency rates compared with historical arteriovenous graft constructions. The high incidence of wound complications and ischemic steal syndrome, however, should temper enthusiasm for applying this technique to all patients who are not candidates for AVF creation with upper extremity vein.

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