Caco Gentian, Golemi Dhurata, Likaj Eriola
Vascular Surgery Service, UHC "Mother Teresa", Tirana - Albania.
Nephrology and Haemodialysis Unit, Regional Hospital of Shkodra, Shkodra - Albania.
J Vasc Access. 2017 Mar 21;18(2):e15-e17. doi: 10.5301/jva.5000608.
The saphenous vein is commonly used as a vascular graft in peripheral artery surgery but rarely used for vascular access. The literature on straight configuration saphenous vein transposition to the popliteal artery is scarce. Here we present two cases of straight configuration saphenous vein transposition to the popliteal artery for vascular access, the surgical technique and respective follow-up.
Two young men, aged 29 and 36 years, were chosen for lower-limb vascular access for hemodialysis. The first patient was paraplegic since birth. He used his arms to move so upper extremity vascular access was avoided. The second patient presented with an infected upper extremity arteriovenous graft (AVG) and after multiple closed AVFs he had no more available arm veins. Both patients received autologous lower extremity straight configuration saphenous vein transpositions to the popliteal artery under spinal anesthesia in May and October 2012, respectively. Cannulation of the fistula was allowed after one month. There were no early complications. Slight swelling on the leg appeared in one of the patients. Both fistulas were still functional after 36 and 32 months, respectively.
The straight configuration saphenous vein transposition to popliteal artery is simple to perform, offers a long and straight segment for cannulation and may be a suitable autologous vascular access in selected patients.
大隐静脉在外周动脉手术中常用作血管移植物，但很少用于血管通路。关于大隐静脉直线段转位至腘动脉的文献较少。在此，我们报告两例大隐静脉直线段转位至腘动脉用于血管通路的病例、手术技术及各自的随访情况。
两名分别为29岁和36岁的年轻男性被选择进行下肢血管通路用于血液透析。首例患者自出生起即截瘫，靠手臂移动，因此避免上肢血管通路。第二例患者上肢动静脉移植物（AVG）感染，在多次闭合动静脉瘘后，其手臂已无可用静脉。两名患者分别于2012年5月和10月在脊髓麻醉下接受了自体下肢大隐静脉直线段转位至腘动脉手术。术后1个月允许对动静脉内瘘进行插管。无早期并发症。其中一名患者腿部出现轻微肿胀。分别在36个月和32个月后，两个动静脉内瘘仍保持功能。
大隐静脉直线段转位至腘动脉操作简单，提供了一段长而直的插管段，对于选定患者可能是合适的自体血管通路。
