Some disadvantages by using AV fistula by the transposition of the femoral vein was necessity for a more extensive & deeper dissection which will use a larger vessels & make it even more susceptible to infection & steal syndrome. Such type of problems were also observed & motivated to seek a new alternative method, by using a saphenous vein in “bridge” conformation, anastomosed to the superficial femoral artery near to the adductor canal. The major benefits of this method encouraged us to expand the study with a larger number of patients, and analyzing the results of the clinical experience and late complications and risks.
PROCEDURE:
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The method was done with the patient under local anesthesia. Systemic heparinization will be used.
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The axillary vein was accessed by a 5-cm – 6-cm subclavicular incision or cut, and through axillary incision.
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A long saphenous vein was dissected at saphenofemoral junction & 5 to 6 cm distally. An 8-mm polytetrafluoroethylene (PTFE) graft was then inserted subcutaneously to bridge the two veins.
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The graft was standard wall & thin wall was externally supported. A 10-mm venotomy were made in axillary vein, & a 20-mm venotomy in the saphenous vein.
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The graft was then anastomosed end-to-side to veins. The great saphenous vein were not ligated distally Graft patency during follow-up are controlled by murmur auscultation and Doppler ultrasound scanning for every 3 months.
