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Latero-lateral femoro-femoral arteriovenous fistula: a new surgical approach for hemodialysis patients with no vascular access / Fístula artériovenosa fêmoro-femoral látero-lateral: uma nova abordagem para hemodiálise de pacientes sem opção de acesso vascular
Cerri, Jesualdo; Ramacciotti, Eduardo; Gomes, Marise; Tedeschi Filho, Wagner; Piccinato, Carlos Eli.
  • Cerri, Jesualdo; University Hospital. Ribeirao Preto School of Medicine. Department of Surgery and Anatomy.
  • Ramacciotti, Eduardo; University of Michigan. Research Laboratories, Vascular Surgery. US
  • Gomes, Marise; University of Michigan. Research Laboratories, Vascular Surgery. US
  • Tedeschi Filho, Wagner; University Hospital. Ribeirao Preto School of Medicine. Department of Surgery and Anatomy.
  • Piccinato, Carlos Eli; University Hospital. Department of Surgery and Anatomy.
Acta cir. bras ; 26(1): 72-76, jan.-fev. 2011. ilus, tab
Article in English | LILACS | ID: lil-572237
ABSTRACT

Purpose:

A new surgical approach for vascular access for hemodialysis using a latero-lateral arteriovenous fistula (AVF) in the thigh between the femoral artery (FA) and superficial femoral vein (SFV) transposed to the subcutaneous layer in patients with no other access options is described.

Methods:

Ten patients (mean age 37,9 years) for whom all possible sites for execution of any other procedure had been exhausted, underwent latero-lateral AVF close to the adductor channel between the FA and the SFV. The FSV was released and sectioned 2 cm from its confluence with the deep femoral vein and transposed in the subcutaneous tissue with extensions using saphenous vein or prosthetic material (PTFE) when needed. Follow -up included patency, flow evaluation and complications.

Results:

Postoperative follow-up ranged from 3 to 96 months, with a mean of 38 months. The AVFs presented a flow of more than 350 ml/min and the AVFs remained patent for a mean period of 38 months. There were three failures of the procedures at 3, 5 and 7 months during postoperative follow-up due to graft infection and thrombosis (a case), anaphylactic shock and thrombosis (a case) and calf pain during dialysis (a case). Two patients developed slight inferior limb edema.

Conclusion:

The new surgical approach for access for hemodialysis represents a feasible procedure, with acceptable patency rates in exceptional cases where no other access option is available.
RESUMO

Objetivo:

Nova abordagem para acesso vascular para hemodiálise usando fistula artério-venosa (FAV) látero-lateral na coxa entre a artéria femoral (AF) e a veia femoral superficial (VFS) transposta no subcutâneo em pacientes sem opção de acesso.

Métodos:

Dez pacientes (idade média 37,9 anos), cuja possibilidade de acesso havia sido exaurido, foram submetidos a FAV látero-lateral na coxa entre a AF e a VFS.Esta veia foi liberada e seccionada 2 cm de sua confluência com a veia femoral profunda e transposta no plano superficial com extensão usando a veia safena ou material protético (PTFE) quando necessário.O seguimento incluíu a perviedade , fluxo e complicações.

Resultados:

O seguimento pós-operatório foi de 3 a 96 meses (média 38). A FAV apresentou fluxo mínimo de 350 ml/min e permaneceu pérvia no período médio de 38 meses. Houve 3 falências aos 3, 5, e 7 meses pós-operatórios por infecção de prótese e trombose da FAV (um caso), choque anafilático e trombose (um caso) e dor na panturrilha na hemodiálise (um caso). Dois pacientes desenvolveram discreto edema de membro inferior.

Conclusão:

A nova abordagem para acesso vascular para hemodiálise representa um procedimento factível, com aceitável perviedade em casos excepcionais onde nenhum outro acesso é disponível.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Arteriovenous Shunt, Surgical / Renal Dialysis / Femoral Artery / Femoral Vein / Kidney Failure, Chronic Limits: Adult / Female / Humans / Male Language: English Journal: Acta cir. bras Journal subject: General Surgery / Procedimentos Cir£rgicos Operat¢rios Year: 2011 Type: Article Affiliation country: United States Institution/Affiliation country: University of Michigan/US

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Full text: Available Index: LILACS (Americas) Main subject: Arteriovenous Shunt, Surgical / Renal Dialysis / Femoral Artery / Femoral Vein / Kidney Failure, Chronic Limits: Adult / Female / Humans / Male Language: English Journal: Acta cir. bras Journal subject: General Surgery / Procedimentos Cir£rgicos Operat¢rios Year: 2011 Type: Article Affiliation country: United States Institution/Affiliation country: University of Michigan/US