COMPARATIVE EVALUATION OF VASCULAR CONDUITS FOR HEMODIALYSIS ACCESS: LONG SAPHENOUS VEIN VERSUS SUPERFICIAL FEMORAL VEIN

Abstract

Background: Hemodialysis of end-stage renal disease (ESRD) requires reliable vascular access. Long saphenous vein (LSV) is used universally, although the superficial femoral vein (SFV) is also being used as an alternative to LSV when LSV is not appropriate. There is limited data available on the comparative data on patency, complications, and functional outcomes of these conduits.

Objectives: To compare the efficacy of the long saphenous vein and superficial femoral vein with respect to primary and assisted primary patency, secondary patency, and complications.

Methodology: It was a retrospective single-center study with a sample size of 25 ESRD patients who were in Department of Vascular Surgery, Combined Military Hospital Rawalpindi 6 months lower-limb venous conduits. The patients were separated into two groups (LSV-n=12 and SFV-n=13) in accordance with their preoperative suitability of the vein evaluated using duplex ultrasonography. Vein harvesting and arteriovenous fistula creation were performed using the usual surgical procedures. Primary and secondary patency, thrombosis, infection, formation of an aneurysm, and morbidity of the donor site were followed in patients at 1, 3, 6, and 12 months. The statistical analysis was conducted in SPSS; they were analyzed in terms of mean ± standard deviation, t-test, and chi-square, where p<0.05 was regarded as statistically significant.

Results: The mean age was 52.4 ± 9.8 years in the LSV group and 54.1 ± 10.2 years in the SFV group (p=0.62). Primary patency at 12 months was 66.7% for LSV and 84.6% for SFV (p=0.21); secondary patency was 75% versus 92.3% (p=0.18). Thrombosis occurred in 3 LSV and 2 SFV patients. Aneurysms were noted in 1 LSV patient. Infection rates and donor site morbidity were comparable, though mild limb edema occurred in 15.4% of SFV patients.

Conclusion: The substitute for LSV is SFV, which is a dependable choice of hemodialysis access device with better patency and similar complications. Preoperative mapping and the method of surgery are all required to achieve the best results in patients with ESRD.