Composite PTFE-transposed superficial femoral vein for lower limb arteriovenous access

Purpose: We report our experience in creating a composite loop of transposed superficial femoral vein (tSFV) and polytetrafluoroethylene (PTFE) synthetic graft for lower limb access. The indication for surgery was exhaustion of access sites in both upper limbs. Methods: Surgery was performed on 3 male patients. All patients had an ankle brachial index ≥0.9. The SFV was mobilized up to adductor canal, with ligation of all small tributary branches, up to the level below the profunda femoral vein, then tunneled medially to the skin. A 6-mm PTFE graft was tunneled laterally, deep in the subcutaneous plane in loop fashion to the end of the tSFV, where a beveled end-to-end anastomosis was created. Results: The blood flow in both fistulas increased gradually to 0.7-1.3 l/min postoperatively. No clinical manifestation indicative of lower limb ischemia, lymphorrhea, or infection was documented. No signs related to chronic venous hypertension were noticed. Conclusions: Our initial experience shows that the creation of a composite PTFE-tSFV conduit is a promising technique, since it can be constructed without compromising the distal perfusion, and without infectious complications.