Small skin incision and fistula elevation for hemodialysis using the femoral vein

BackgroundWound morbidity commonly accompanies transposition of the femoral vein when used for hemodialysis access, mainly because of the length of the skin incision. A short incision may reduce wound complications but may compromise the arteriovenous (AV) function because of the shorter length of femoral vein available for puncture. This report presents our experience with a modification of the original technique, in which a smaller skin incision and fistula elevation were used.MethodsThe clinical course of 25 AV fistulas in the thigh using the femoral vein was retrospectively analyzed. The original technique to create femoral AV access was used in 12 patients and the modified technique in 13. The procedures were performed between 2005 and 2007, and patients were monitored until January 31, 2011.ResultsThree fistulas failed in each group. Five patients in the original group had wound complications. No wound complications occurred in the modified group. The fistula was first used at an average of 10.45 weeks and 6.14 weeks, respectively. Patency was similar in both groups.ConclusionsIt is possible to obtain a functional AV fistula in the thigh using the femoral vessels and limiting the extent of the incision. Long-term patency is reasonable, despite the use of a short femoral segment for puncture.