Femoral Vein Translocation for Complex Hemodialysis Access

Abstract

ObjectiveVascular access is difficult in patients without suitable arm veins and prior graft infections. The use of femoral vein translocation to the upper extremity or contralateral lower extremity for hemodialysis access may be associated with low infection rates and high patency rates. Femoral vein translocation is used for patients without central venous occlusion who have failed prior access either due to graft infection or repetitive graft thrombosis. The largest case series consists of 30 cases. The objective of this study is to determine the infection incidence, primary patency, primary-assisted patency, and secondary patency rates among femoral vein translocations. MethodsA retrospective chart review was performed on all patients who underwent femoral vein translocation by a single vascular practice over a 10-year period, 2013-2023. Study variables included length to last follow up (months), prior access, prior graft infection, comorbid conditions, primary patency, primary-assisted patency, secondary patency, postoperative steal syndrome, postoperative graft infection, postoperative harvest site complication, and postoperative lower extremity compartment syndrome. ResultsA total of 131 femoral vein translocations were performed from 2013-2023; 126 patients (47% male, 53% female; 76% black, 24% white) with a mean ± SD age of 52 ± 14 years; BMI 29 ± 8 had at least 1 month follow up and were included for analysis. The median (IQR) follow up was 46 (19-72) months. The mean (SD) number of prior permanent accesses was 2.5 ± 1.4. Forty-eight percent of patients had prior graft infections. The primary, primary assisted, and secondary patency rates were 66%, 93%, 98%, respectively, at 6 months; 43%, 85%, 96% at 12 months; 25%, 70%, 92% at 24 months; 16%, 61%, 88% at 36 months; and 14%, 56%, 82% at 48 months. Postoperative steal syndrome and postoperative access infection requiring excision was observed 16% and 5% of patients, respectively. Harvest site complications requiring an additional procedure occurred in 19% of cases. Three patients developed lower extremity compartment syndrome postoperatively, requiring fasciotomy. Six patient developed chronic lower extremity edema after femoral vein harvest. Mean ± SD procedure time and hospital length of stay was 197 ± 40 minutes and 3.5 ± 2.8 days, respectively. ConclusionFemoral vein translocation is associated with low infection rates and high long-term patency rates. Significant postoperative complications include steal syndrome and harvest site complications. Femoral vein translocation remains a viable option for patients who have failed prior access due to graft infection or repetitive graft thrombosis.