Faris Alomran, Benoit Boura, Alexandros Mallios, Romain De Blic, Alessandro Costanzo, Myriam Combes
IMM, Paris, France.
BACKGROUND: Vascular surgeons are sometimes faced with central vein occlusions and other situations where upper limb fistulas are not viable. In the lower limb, prosthetic grafts have been the mainstay conduit for dialysis access with high rates of occlusion and infection. Some authors have published data on the use of the femoral superficial vein; however, this is a long complex procedure with significant disruption of the lower limb venous return. The greater saphenous vein (GSV) has proved previously to be a poor conduit due to its resistance to dilatation, and only few reports have mentioned its effective use in dialysis. The technique exhibited in this video results in a doubled diameter of the GSV, allowing easy puncture and effective dialysis. It has all the advantages of an autologous conduit without the morbidity associated with the superficial femoral vein graft. We also believe that this technique can be used in other locations, such as the upper limb in selected patients not candidates for prosthetic grafts.
TECHNICAL DESCRIPTION: After harvesting the required length of the GSV, it is opened longitudinally up to approximately 5cm from the saphenofemoral junction (but not sectioned vertically to avoid the requirement for a veno-venous anastomosis). The GSV is freed from all valves and then folded in 2, creating one anterior and one posterior vein panel. The lateral edges of the panels are sutured together, and the medial edges together effectively creating a cylinder, while doubling the initial GSV diameter. After venous testing, the vein is tunnelled subcutaneously and down to the superficial femoral artery (SFA). The size of the anastomosis is tailored to avoid lower limb steal syndrome. The vein is anastomosed to the SFA.
AUTHOR DISCLOSURES: F. Alomran: Nothing to disclose; B. Boura: Nothing to disclose; M. Combes: Nothing to disclose; A. Costanzo: Nothing to disclose; R. De Blic: Nothing to disclose; A. Mallios: Nothing to disclose.
Posted April 2013