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The need for alternative vascular access methods in young patients with exhausted vascular access in the upper limbs is crucial to improve their quality of life and reduce the risk of complications associated with permanent catheters and femoral prostheses.
Several vascular access techniques have been proposed for young patients with exhausted vascular access in the upper limbs, including the use of femoral vessel prostheses, but these are associated with various complications.
There is a lack of information on a vein technique that avoids the use of prostheses in these cases
The femoral vein transposition technique is a promising alternative to traditional vascular access methods, as it avoids the use of prostheses and has the potential to improve patient outcomes.
The aim of this study is to evaluate the effectiveness of the femoral vein technique in young patients with exhausted vascular access in the upper limbs, compared to traditional vascular access methods.
In some, another AVF is performed with femoral vessel prostheses, but the problems associated with
the prostheses continue.
For this reason we think about a vein technique. We avoid the risk of AVFs with prostheses.
Patients with contraindications to peritoneal dialysis must be added to this group.
The objective is to avoid permanent catheters and femoral prostheses in young patients with exhaustion of vascular access in the upper limbs.
It is a surgery that requires skill and patience, 3 to 5 hours.
Upper limb vascular access exhausted and peritoneal blockage.
Between April 2016 and June 2023 we performed 2,352 vascular access surgeries of which 25 were femoral transpositions.
The age was between 30 and 57 years.
14 women and 11 men.
1 diabetic patient.
All had lower limb distal pulses present.
No patient had varicose veins.
The caliber of the superficial femoral veins were originally between 7 and 9 mm.
On the original description by Gradman in California in 2001.
WE PROVIDE MODIFICATIONS.
• Staged incisions
• Preserve the saphenous
• Dissect to infra genicular
•Without prosthesis
• Supragenicular anastomosis in popliteal artery.
• Do not reduce the mouth of the vein
PATIENT´S INCLUSION CRITERIA IN THIS SERIES
-Distal Tibial palpable Pulses
- No DVT
-Saphenous preserved
-No age limit
-DBT is not a contraindication
Those who accepted this surgery are due to the rejection of the permancath.
We prefer the femoral vein to the saphenous vein due to early fibrosis in our experience.
We also prefer this technique to other PTFE cone prostheses or femoral artery superficialization.
Results
100% PATENCY IN ALL PATIENTS AFTER 1 AND 4 YEARS
Allows a space of about 25-30 cm for punctures
3 complicated patients:
- complication of a wound segment, was closed with simple dressings
- edema and deep vein thrombosis, remains anticoagulated
- proximal femoral vein stenosis, was repaired with 8 mm PTFE
The results demonstrate a 100% success rate, after 1 to 4 years of follow-up.
Results in long puncture space for cannulation
- MORE TOLERANCE TO HYPOTENSION
- MORE TOLERANCE TO INFECTIONS
- GREATER EXPECTATION OF PATENCY
We recommend this technique for patients with access exhaustion in the upper limbs to be performed by experienced surgeons.
WE HAVE TO GET MORE EXPERIENCE TO SEE LONG TERM RESULTS.
WE ARE DESIGNING A PROTOCOL FOR A MULTICENTRIC STUDY