Vascular access for Chronic Dialysis using the Superficial Femoral                     Vein

Maintaining peripheral vascular access represents a major challenge for medical providers and patients leading to the emergence of ultrasound guided vascular access teams. Upper extremity peripheral vascular access options are often limited in the chronically ill patient population with end stage cancer, patients with severe contractures, tracheostomies, and feeding tubes and patients referred for palliative care are just some examples of patients who live with difficult access. The following is a case description of a mid-thigh superficial femoral vein midline catheter for comfort care medications in a patient with exhausted peripheral vasculature on hospice.

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Vascular Access Using the Superficial Femoral Vein

The Journal of Vascular Access ◽

10.5301/jva.2010.2748 ◽

2010 ◽

Vol 11 (4) ◽

pp. 312-315 ◽

Cited By ~ 5

Author(s):

John M. Scollay ◽

Richard J.E. Skipworth ◽

Alison Severn ◽

John Nagy ◽

Alison Howd ◽

...

Keyword(s):

Vascular Access ◽

Femoral Vein ◽

Superficial Femoral Vein

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Latero-lateral femoro-femoral arteriovenous fistula: a new surgical approach for hemodialysis patients with no vascular access

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000100013 ◽

2011 ◽

Vol 26 (1) ◽

pp. 72-76 ◽

Cited By ~ 3

Author(s):

Jesualdo Cerri ◽

Eduardo Ramacciotti ◽

Marise Gomes ◽

Wagner Tedeschi Filho ◽

Carlos Eli Piccinato

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Surgical Approach ◽

Subcutaneous Tissue ◽

Femoral Vein ◽

Graft Infection ◽

Prosthetic Material ◽

Superficial Femoral Vein ◽

Limb Edema

Purpose: A new surgical approach for vascular access for hemodialysis using a latero-lateral arteriovenous fistula (AVF) in the thigh between the femoral artery (FA) and superficial femoral vein (SFV) transposed to the subcutaneous layer in patients with no other access options is described. Methods: Ten patients (mean age: 37,9 years) for whom all possible sites for execution of any other procedure had been exhausted, underwent latero-lateral AVF close to the adductor channel between the FA and the SFV. The FSV was released and sectioned 2 cm from its confluence with the deep femoral vein and transposed in the subcutaneous tissue with extensions using saphenous vein or prosthetic material (PTFE) when needed. Follow -up included patency, flow evaluation and complications. Results: Postoperative follow-up ranged from 3 to 96 months, with a mean of 38 months. The AVFs presented a flow of more than 350 ml/min and the AVFs remained patent for a mean period of 38 months. There were three failures of the procedures at 3, 5 and 7 months during postoperative follow-up due to graft infection and thrombosis (a case), anaphylactic shock and thrombosis (a case) and calf pain during dialysis (a case). Two patients developed slight inferior limb edema. Conclusion: The new surgical approach for access for hemodialysis represents a feasible procedure, with acceptable patency rates in exceptional cases where no other access option is available.

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Morphometric characteristics of competent proximal valves of the great saphenous vein and superficial femoral vein in vivo according to ultrasound angioscanning data

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2019-18-3-16-22 ◽

2019 ◽

Vol 18 (3) ◽

pp. 16-22

Author(s):

E. K. Gavrilov ◽

H. L. Bolotokov ◽

E. A. Babinets

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Lower Boundary ◽

Average Diameter ◽

Lower Limbs ◽

Functional Test ◽

Natural Form ◽

Superficial Femoral Vein ◽

Venous Diameter

Introduction. It seems relevant to study the ultrasound anatomy and physiology of the proximal valve segments of the superficial femoral vein (SFV) and the great saphenous vein (GSV) to develop effective reconstructive surgical interventions on venous valves in chronic vein diseases.The aim of the survey was to study the ultrasound anatomy of the venous wall, the size and shape of the proximal SFV and GSV valves are normal at rest and during the functional test Valsalva.Material and methods. Proximal valve SFV studies were performed in 144 lower limbs in 115 people (mean age 51.1 ± 14.4 years, 60 women and 55 men), proximal GSV valves studies - in 82 lower limbs in 67 persons (average age 45, 1 ± 13.3 years, 33 women, 34 men). A longitudinal and transverse ultrasound scanning of the femoral vein bifurcation and safenofemoral junction areas were performed, the structures of the proximal SFV and GSV valves were visualized, the valve shape was measured and the diameter of the veins was measured at the level valves at the base of the valves (inlet diameter), at the point of maximum ectasia (diameter of ectasia), at the upper border of the valve (diameter of the outlet), as well as measuring the length of the valve a (length to ectasia, the total length of the valve). The degree of ectasia over the valve was judged by calculating the relative venous diameter change (RVDC).Results. the average diameter of the SFV at the level of the lower boundary of its first valve was 10.01 ± 1.44 mm. The average diameter of the SFV at the level of the maximum ectasia of its first valve was 13,1±2 mm. The average value of the index of RVDC for SFV was 31%±10,4%. An increase in the diameter of the vein in the zone of supravalvular ectasia up to 20% corresponded to the spindle-shaped valve, more than 20% - to the clavate form, which was noted in the majority of the examined. The change in the relative venous diameter of the SFV on the Valsalva test was 38,2%±12,4%. The average diameter of the GSV at the base of the first valves was 6,07±1,25 mm. The average diameter of the GSV at the level of the maximum ectasia of the osteal valve was 9,44±1,69 mm. The average RVDC for GSV was 58%±24%.Conclusion. the natural form of proximal SFV and GSV valves is clavate with presence of the significant supravalvular ectasia, which was noted in the majority of the subjects alone and in all during the performance of the Valsalva functional test.

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Effects of intermittent pneumatic compression on femoral vein peak venous velocity during active ankle exercise

Journal of Orthopaedic Surgery ◽

10.1177/2309499021998105 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199810

Author(s):

Kenta Sakai ◽

Naonobu Takahira ◽

Kouji Tsuda ◽

Akihiko Akamine

Keyword(s):

Femoral Vein ◽

Bed Rest ◽

Intermittent Pneumatic Compression ◽

Postoperative Rehabilitation ◽

Venous Flow ◽

Compression Phase ◽

Superficial Femoral Vein ◽

Inpatient Ward ◽

Vein Thrombosis ◽

Strong Compression

Introduction: The risk of developing deep vein thrombosis (DVT) is high even after the period of bed rest following major general surgery including total joint arthroplasty (TJA). Mobile intermittent pneumatic compression (IPC) devices allow the application of IPC during postoperative exercise. Although ambulation included ankle movement, no reports have been made regarding the effects of IPC during exercise, including active ankle exercise (AAE), on venous flow. This study was performed to examine whether using a mobile IPC device can effectively augment the AAE-induced increase in peak velocity (PV). Methods: PV was measured by Doppler ultrasonography in the superficial femoral vein at rest, during AAE alone, during IPC alone, and during AAE with IPC in 20 healthy subjects in the sitting position. PV in AAE with IPC was measured with a mobile IPC device during AAE in the strong compression phase. AAE was interrupted from the end of the strong compression phase to minimize lower limb fatigue. Results: AAE with IPC (76.2 cm/s [95%CI, 69.0–83.4]) resulted in a significant increase in PV compared to either AAE or IPC alone (47.1 cm/s [95%CI, 38.7–55.6], p < 0.001 and 48.1 cm/s [95%CI, 43.7–52.4], p < 0.001, respectively). Discussion: Reduced calf muscle pump activity due to the decline in ambulation ability reduced venous flow. Therefore, use of a mobile IPC device during postoperative rehabilitation in hospital and activity including self-training in an inpatient ward may promote venous flow compared to postoperative exercise without IPC. Conclusion: Use of a mobile IPC device significantly increased the PV during AAE, and simultaneous AAE with IPC could be useful evidence for the prevention of DVT in clinical settings, including after TJA.

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