Clinique Jouvenet, Paris, France.
J Vasc Surg. 2012 Aug;56(2):440-5. doi: 10.1016/j.jvs.2012.01.068. Epub 2012 May 9.
When all access options in the upper limbs have been exhausted, an autogenous access in lower limb is a valuable alternative to arteriovenous grafts. We report our experience of transposition of the femoral vein (tFV).
From June 1984 to June 2011, 70 patients underwent 72 tFV in two centers (Paris and Meknès) with the same technique. All patients had exhausted upper arm veins or had central vein obstructions. Patients were followed by serial duplex scanning. All complications were recorded and statistical analysis of patency was performed according to intention to treat using the life-table method.
The mean interval between initiation of dialysis and creation of the tFV was 10 years. The sex ratio was even (one female/one male). Mean age was 48 years (range, 1-84 years), and there were no postoperative infections. Duplex measurements in 33 patients indicated high-flow: mean = 1529 ± 429 mL/min; range, 700-3000 mL/min. Two immediate failures were observed and four patients were lost to follow-up soon after the access creation. Ten patients (14%) experienced minor complications (hematoma, five; lymphocele, one; delayed wound healing, two; distal edema, two) and 30 patients (42%) experienced mild complications (femoral vein and outflow stenosis, 16 [treated by percutaneous transluminal angioplasty, 13, or polytetrafluoroethylene patch, three]; puncture site complications, three [ischemia, two; infection, one]; reversible thrombosis, three [two surgical and one percutaneous thrombectomy]; abandoned thrombosis, eight [11%] after a mean patency of 8.1 years). Thirteen patients (18%) experienced major complications necessitating fistula ligation (ischemic complications, five diabetic patients with peripheral arterial occlusive disease [one major amputation included]; lower leg compartment syndrome, one; acute venous hypertension, two; secondary major edema, two; high-output cardiac failure, one; bleeding, two). All the patent accesses (59/72) were utilized for dialysis after a mean interval of 2 ± 1 months (range, 1-7 months) resulting in an 82% success rate. According to life-table analysis, the primary patency rates at 1 and 9 years were 91% ± 4% and 45% ± 11%, respectively. The secondary patency rates at 1 and 9 years were 84% ± 5% and 56% ± 9%, respectively.
Femoral vein transposition in the lower limb is a valuable alternative to arteriovenous grafts in terms of infection and long-term patency. Secondary venous percutaneous angioplasties may be necessary. High flow rates are frequently observed and patient selection is essential to avoid ischemic complications.
当上肢的所有入路选择都已用尽时，下肢的自体入路是动静脉移植物的有价值的替代方案。我们报告了股静脉转位（tFV）的经验。
1984 年 6 月至 2011 年 6 月，在两个中心（巴黎和梅克内斯），70 名患者进行了 72 例 tFV，采用相同的技术。所有患者均已耗尽上臂静脉或存在中心静脉阻塞。通过连续双功能超声检查对患者进行随访。记录所有并发症，并根据意向治疗，采用寿命表法对通畅性进行统计学分析。
开始透析和建立 tFV 之间的平均间隔为 10 年。性别比例均等（1 名女性/1 名男性）。平均年龄为 48 岁（范围 1-84 岁），无术后感染。33 名患者的双功能超声检查显示高流量：平均=1529±429mL/min；范围，700-3000mL/min。观察到 2 例即刻失败，4 例患者在入路建立后不久失访。10 名患者（14%）出现轻微并发症（血肿，5 例；淋巴囊肿，1 例；延迟伤口愈合，2 例；远端水肿，2 例）和 30 名患者（42%）出现轻度并发症（股静脉和流出道狭窄，16 例[经皮腔内血管成形术治疗 13 例，聚四氟乙烯补丁治疗 3 例]；穿刺部位并发症，3 例[缺血，2 例；感染，1 例]；可逆性血栓形成，3 例[2 例手术，1 例经皮血栓切除术]；血栓形成放弃，8 例[11%]，平均通畅时间为 8.1 年）。13 名患者（18%）出现需要结扎瘘管的严重并发症（缺血性并发症，5 例糖尿病合并外周动脉闭塞性疾病[包括 1 例主要截肢]；小腿间隔综合征，1 例；急性静脉高压，2 例；继发性大水肿，2 例；高输出量心力衰竭，1 例；出血，2 例）。所有通畅的通路（59/72）在平均 2±1 个月（范围 1-7 个月）后用于透析，成功率为 82%。根据寿命表分析，1 年和 9 年的主要通畅率分别为 91%±4%和 45%±11%。1 年和 9 年的次要通畅率分别为 84%±5%和 56%±9%。
股静脉在下肢的转位在感染和长期通畅方面是动静脉移植物的有价值的替代方案。可能需要进行二次静脉经皮血管成形术。经常观察到高流量，患者选择对于避免缺血性并发症至关重要。
