Adjunctive Use of the Superficial Femoral Vein for Vascular Reconstructions

Abstract

Objectives: While the superficial femoral vein (SFV) is an accepted treatment for aortic graft infections, this conduit also has potential uses in other areas. We evaluate our experience using the SFV for arterial and venous bypasses, and arteriovenous (AV) fistula for dialysis access. Methods: Between 1999-2011, 42 patients underwent a bypass or a thigh AV fistula using the SFV (31 arterial, 4 central venous, 6 AV fistula, and 1 common carotid-to-vertebral bypass). Indications for arterial bypass included: infected graft (20), critical limb ischemia (9), and failed previous bypass (4). Indications for central venous bypass were: SVC syndrome (2); vessel reconstruction due to tumor encasement (1); and central vein occlusion from thoracic outlet syndrome (1). All AV fistulas were created after patients suffered bilateral subclavian vein occlusions from failed upper extremity access. The common carotid-to-vertebral bypass was created due to an occluded vertebral artery with resultant stroke. Results: Kaplan Meier cumulative patency curves are shown in the Fig. The primary patency rates at 30 days, 1 and 3 years were 97.4% (95% CI, 92.41,100), 74.6% (95% CI, 57.89,96.23) and 66.4% (95% CI, 47.06,93.53), respectively. The assisted primary patency rates at 30 days, 1, and 3 years were 100% (95% CI, 100,100), 97.1% (95% CI, 91.54,100) and 89% (95% CI, 74.29,100), respectively. Secondary patency rates at 30 days, 1, and 3 years were 100% (95% CI, 100,100), 97.1% (95% CI, 91.54,100) and 89% (95% CI, 74.29,100), respectively. Limb salvage rates at 30 days, 1, and 3 years were 97.3% (95% CI, 92.21,100), 89.3% (95% CI, 78.35,100), and 89.3% (95% CI, 78.35,100), respectively. Survival rates at 30 days, 1, and 3 years were 97.6% (95% CI, 92.95,100), 86% (95% CI, 75.3,98.3), and 86% (95% CI, 75.3,98.3), respectively. Follow-up ranged from 1 month to 8.7 years (mean time, 21 months). Complications occurred in 22 patients (52%) and included: wound complications (n = 19, 45.2%); deep vein thrombosis (n = 1, 2.4%); anastomotic breakdown (n = 1, 2.4%); hematoma (n = 5, 11.9%); pulmonary embolism (n = 2, 4.8%); and compartment syndrome (n = 2, 4.8%). Conclusions: The SFV is a durable conduit for uses beyond aortic reconstruction and should be considered when the GSV is not available, or size match is a concern. However, wound complications remain a problem.