Adjunctive use of the superficial femoral vein for vascular reconstructions.

Abstract

OBJECTIVE:

Although the superficial femoral vein (SFV) is an accepted treatment for aortic graft infections, this conduit also has potential uses in other areas. Herein, we evaluate our experience using the SFV for arterial and venous bypasses and the arteriovenous (AV) fistula for dialysis access.

METHODS:

Between 1999 and 2011, 42 patients underwent a bypass or a thigh AV fistula using the SFV (31 arterial, four central venous, six AV fistulas, and one common carotid-to-vertebral bypass). Indications for arterial bypass included infected graft (20), critical limb ischemia (nine), and failed bypass (six). Indications for central venous bypass were: superior vena cava syndrome (two), vessel reconstruction due to tumor encasement (one), and central vein occlusion from thoracic outlet syndrome (one). All AV fistulas were created after patients sustained bilateral subclavian vein occlusions from failed upper extremity access. The common carotid-to-vertebral bypass was created due to an occluded vertebral artery with resultant stroke.

RESULTS:

Kaplan-Meier cumulative patency curves were used. The primary patency rates at 30 days, 1 year, and 3 years were 97.4% (95% confidence interval [CI], 92.41-100), 74.6% (95% CI, 57.89-96.23), and 66.4% (95% CI, 47.06-93.53), respectively. The assisted primary patency rates at 30 days, 1 year, and 3 years were 100% (95% CI, 100-100), 97.1% (95% CI, 91.54-100), and 89% (95% CI, 74.29-100), respectively. Secondary patency rates at 30 days, 1 year, and 3 years were 100% (95% CI, 100-100), 97.1% (95% CI, 91.54-100), and 89% (95% CI, 74.29-100), respectively. Limb salvage rates at 30 days, 1 year, and 3 years were 97.3% (95% CI, 92.21-100), 93.6% (95% CI, 78.35-100), and 93.6% (95% CI, 78.35-100), respectively. Survival rates at 30 days, 1 year, and 3 years were 97.6% (95% CI, 92.95-100), 86% (95% CI, 75.3-98.3), and 86% (95% CI, 75.3-98.3), respectively. Follow-up ranged from 1 month to 8.7 years (mean time, 21 months). Complications occurred in 22 patients (52%) and included wound complications (n = 19; 45.2%); deep vein thrombosis (n = 1; 2.4%); anastomotic breakdown (n = 1; 2.4%); hematoma (n = 4; 9.5%); pulmonary embolism (n = 2; 4.8%); and compartment syndrome (n = 2; 4.8%).

CONCLUSIONS:

The SFV is a durable conduit for uses beyond aortic reconstruction and should be considered when the great saphenous vein is not available or size match is a concern. However, wound complications remain a problem.

• Authors: Soma Brahmanandam, Daniel Clair, James Bena, Timur Sarac
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 55 Issue 5 Pg. 1355-62 (May 2012) ISSN: 1097-6809 [Electronic] United States
• PMID: 22459743 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Aged
• Arteriovenous Shunt, Surgical (methods)
• Blood Vessel Prosthesis (adverse effects)
• Catheter-Related Infections (etiology, physiopathology, surgery)
• Disease-Free Survival
• Female
• Femoral Vein (surgery)
• Humans
• Ischemia (surgery)
• Kaplan-Meier Estimate
• Limb Salvage
• Lower Extremity (blood supply)
• Male
• Middle Aged
• Ohio
• Postoperative Complications (etiology)
• Renal Dialysis
• Reoperation
• Retrospective Studies
• Superior Vena Cava Syndrome (surgery)
• Thoracic Outlet Syndrome (surgery)
• Time Factors
• Treatment Outcome
• Vascular Diseases (etiology, physiopathology, surgery)
• Vascular Patency
• Vascular Surgical Procedures (adverse effects)