Femoral vein transposition arteriovenous fistulas ensure effective hemodialysis access in patients with exhausted upper extremity options.

BACKGROUND

Femoral vein transposition arteriovenous fistula (FV tAVF) has been used for vascular access in hemodialysis patients with exhausted upper limb options or central venous occlusion. This study evaluated the safety and 60-month primary patency of femoral vein FV tAVFs for hemodialysis access.

METHODS

This multicenter, retrospective study included 32 adult patients undergoing FV tAVF creation. Patients included in the study had exhaustion or unavailability of upper arm veins or bilateral upper central venous occlusion and adequate lower extremity circulation. Primary and secondary patency rates were evaluated at 6, 12, 24, and 60 months. Complications were also analyzed. Exploratory analyses included the impact of demographic and clinical variables on primary and secondary patency rates.

RESULTS

Technical success was achieved in 90.63% of cases. Primary patency rates were 90.63% at 6 months, 84.38% at 12 months, 60% at 24 months, and 18.18% at 60 months. Secondary patency rates were 90.63% at 6 and 12 months, 79.31% at 24 months, and 36.84% at 60 months. Wound complications occurred in 46.88% of patients, with most managed conservatively. Steal syndrome and venous thrombosis were observed in 18.15% and 12.5% of patients, respectively. Female sex and wound complications impacted secondary patency, while a shorter duration of hemodialysis (<27 months) correlated with higher primary patency loss.

CONCLUSION

FV tAVF is a feasible and reliable vascular access option for complex patients, providing robust maturation and patency rates, with manageable complication profiles.