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PubMedDate not supplied

Femoral vein transposition versus femoral loop grafts for hemodialysis: a prospective evaluation.

In this first clinical trial femoral vein transposition (FVT) was prospectively compared with its "graft" counterpart. Patients requiring vascular access due to occluded central veins were divided into two groups: group I (n = 17) underwent femoral loop grafts and group II (n = 15), FVT. Complications were recorded prospectively and patency rates were compared by the Kaplan Meier method with statistical comparisons by Mann Whitney U and chi-square tests as appropriate. Between 1999 and 2003 30 patients underwent 32 operations. Mean follow-up was 8.9 months in group I and 6.8 months in group II (P >.05). Three group I patients developed a steal, requiring closure of the fistula in one. Five group II patients developed a steal, requiring closure of the fistula in one. The incidence of steal was similar in both groups (P >.05). The infection rates were similar: 35.3% and 26.7% in group I versus group II (P >.05), respectively. Among the six infections in group I, four patients required excision of the graft due to infection, whereas only one arteriovenous fistula (AVF) was closed in group II for infection. The 1-year primary patency rate in group I was 37.5% versus 86.7% in group II (P <.05). In conclusion, Femoral AVF grafts have been condemned because of the unacceptable high rate of septic complications. FVT obviates the need for a graft and has fewer infectious problems and better patency rates.

Arteriovenous Shunt, Surgical↗
PubMed2002

Patency of superficial femoral vein employed as a crossover femoral artery bypass conduit.

This study assesses the patency of superficial femoral vein used as a crossover femoral artery bypass conduit in patients presenting either with localized groin sepsis, generalized sepsis or in patients with occluded or heavily diseased superficial femoral artery outflow. Twenty patients were followed prospectively with femoral crossover grafts constructed of superficial femoral vein. Twelve patients presented with sepsis and 8 with chronic ischemia from iliac artery occlusion and severely diseased superficial femoral artery outflow. Graft patency was assessed with regular duplex ultrasound examination. There was one perioperative death. Six patients died during the follow-up period. Mean follow-up time was 24.3 months. No graft occluded or required revision. There was no limb loss, graft infection, or graft hemorrhage. Superficial femoral vein offers an effective femoral crossover bypass graft in patients with either localized/generalized sepsis or disadvantaged outflow tracts.

Adult↗
PubMed2001

[Aneurysm of the femoral vein as differential diagnosis of femoral hernia].

Venous aneurysms are rare, especially those of the femoral vein. Groin hernias and femoral hernias are in contrast to this more frequent enteties. The literature includes only six cases of aneurysms of the femoral vein. We report on a 61-year-old patient who underwent an operation for femoral hernia. An aneurysm of the femoral vein was found intraoperatively and directly resected. The differential diagnosis of femoral hernias and the following diagnostic and therapeutic strategies are described.

Aneurysm↗
PubMed2006

Correction of superior vena cava syndrome with superficial femoral vein juguloatrial bypass.

Several techniques for bypass of the superior vena cava have been described, including spiraled saphenous vein graft, femoral vein graft, and polytetrafluoroethylene graft as conduits. We present two cases of superior vena cava obstruction treated with juguloatrial bypass using harvested superficial femoral vein. We feel that the superficial femoral vein, with its diameter similar to that of the internal jugular vein, provides several advantages compared to other conduits in a juguloatrial bypass.

Adult↗
PubMed1989

[Tolerance of femoral vein catheterization].

The femoral vein is a convenient venous access site which has remained relatively neglected since earlier reports of major complications. However, over the last 10 years, its beneficial use for various purposes (mainly haemodialysis) justifies a reexamination of the value of femoral venous catheterization. The ease of femoral catheterization and its complications were prospectively studied in 92 intensive care patients. Of the 113 attempts made by physicians, 75% of whom were inexperienced, 103 (91.2%) were successful. Insertion resulted in 17 (15%) arterial punctures and 5 local hematomas. Seventy catheters were left in place for an average of 8.8 days. No clinical manifestations of thrombosis were observed. Bilateral phlebography was carried out before removal of the catheter in 70 cases; 45 (64%) of these controls were normal. Of the remaining 25 pathological phlebograms, there were 11 (15.7%) fibrin sleeves, 2 (2.8%) partial thromboses of the common femoral vein which could be directly linked to the venous cannulation, and various abnormalities not directly due to the catheterization (superficial femoral vein thrombosis (4), thrombosis of calf or popliteal veins (18]. One case of catheter septicaemia occurred. Microorganisms were present in 15 (18.3%) of 82 catheter cultured tips. Percutaneous catheterization of the femoral vein might therefore be considered as a good venous access route. It can be successfully used by inexperienced physicians. There is no serious risk of injury to surrounding structures and the risks of thrombosis and infection are acceptable in comparison with other routes.

Adolescent↗
PubMed2001

[Injury of the femoral vein during surgery of a femoral hernia].

In a 38-year-old female patient during surgery of a femoral hernia by the crural approach injury-two stitches of the femoral vein occurred which was not noticed during surgery. After surgery a haematoma developed in the wound from lacerarion of the venous wall. The haematoma was evacuated and the wound healed secondarily. From the first postoperative day swelling of the thigh and foreknee. This finding called after some time for a duplex sonographic and phlebographic examination. Stenosis of the femoral vein, 35 mm in length, and with a 3 mm diameter of the vein was found. Three months after injury of the vein re-operation was performed. During the latter the stitches which stenotized the vein were released and a partial resection of the inguinal ligament was made. Shortly after surgery the oedema receded and the stenosis dilated to a diameter of 8 mm. At present the patient has no complaints.

Adult↗
PubMed1975

Surgical repair of the incompetent femoral vein valve.

Incompetent femoral vein valves are identified by reflux femoral phlebography in selected patients with postphlebitic syndrome. In addition to conventional stripping of varices and subfascial interruption of communicating veins, 14 patients with 17 involved extremities have undergone surgical repair of an incompetent valve in the superficial femoral veins. Pathologic condition of the valve consisted of elongation of the cusp edge. Repair was achieved by a series of tucking sutures shortening the cusp and restoring competence to the valve. Healing of ulcers and relief of swelling occurred in 90% of the patients. This rate was maintained up to seven years. These cases demonstrate the feasibility of surgery on the femoral vein valve. The relative importance of conventional stripping, subfascial communicating vein interruption, and femoral valve repair will have to be established by way of further clinical experience.

Femoral Vein↗
PubMed1992

The effect of venous flow alterations upon patency of rat femoral vein anastomoses.

The rat femoral vein has become a standard model for laboratory training in microvascular anastomotic technique as well as for research investigations into factors affecting venous patency. This study examined the short-term patency (1 and 7 days) of rat vein anastomoses. The influences upon patency of epigastric flap creation and distal femoral vessel ligation (epigastric flow only) were explored. In a separate experiment, blood flow from the femoral vein was determined through catheter collection of venous efflux; the influences of island epigastric flap creation and distal femoral ligation on flow rates were explored. It was found that 82% of basic femoral vein anastomoses were patent at one day, while 100% of anastomoses associated with an epigastric flap and ligated/transected distal femoral vessel circulation (creating a low-tension anastomosis) were patent (P less than 0.01). With distal femoral vessel ligation and no transection (normal tension at the repair), anastomoses were patent in 90% of the veins when an epigastric flap was also raised, and in 60% when a flap was not created. When a flap was raised without disturbing the distal femoral circulation, vein patency was 75% at one day. When the vein anastomosis was performed with distal femoral vein ligation, the patency rate was 50%. All veins patent at 1 day were also patent at 7 days post-op; 96% of veins clotted at 1 day were found to be patent at 7 days. The venous efflux was not found to vary significantly when an epigastric flap was raised.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1991

Internal jugular vein reconstruction using a superficial femoral vein graft.

Numerous methods of venous reconstruction have been described to help prevent the many complications related to bilateral ligation of the internal jugular veins. The authors report a case in which the superficial femoral vein was used as the donor graft for reconstruction of the internal jugular vein in a 61-year-old man who underwent a tonsillar commando procedure for cancer. The advantages of using this donor vein for reconstruction of the internal jugular vein are summarized.

Carcinoma, Squamous Cell↗
PubMed1997

Lower extremity deep vein thrombosis: a prospective, randomized, controlled trial in comatose or sedated patients undergoing femoral vein catheterization.

OBJECTIVES: To determine the rate of lower extremity deep vein thrombosis after the use of femoral catheters in intensive care unit (ICU) comatose or sedated adults. Results were then compared with results of patients undergoing superior vena cava catheterization. DESIGN: Prospective, randomized, controlled, unblinded study. SETTING: A mixed medical/surgical ICU in a university hospital. PATIENTS: Sixty-one comatose or sedated patients admitted to the ICU who underwent central venous catheterization. INTERVENTIONS: Patients were monitored for signs of thrombotic complications. On catheter removal, a lower-extremity bilateral phlebographic examination was performed in each patient. MEASUREMENTS AND MAIN RESULTS: After randomization, 31 patients underwent femoral vein catheterization and 30 patients underwent superior vena cava catheterization, either by axillary (21 patients) or internal jugular vein (10 patients) cannulation. Single lumen polyurethane catheters were inserted for a mean duration of 7.1 +/- 4.6 (SD) days in the femoral vein group and 9.9 +/- 5.5 days in the superior vena cava group (p = NS). No patient had clinical signs of leg venous thrombosis or pulmonary embolism during the study period. In each patient, lower extremity bilateral phlebography was performed at the time of catheter removal. Leg phlebographies were normal in 18 (60%) patients in the femoral vein group and 26 (84%) patients in the superior vena cava group. Fibrin sleeves which developed around the femoral catheters were seen in seven (23.3%) patients in the femoral vein group and in no patients in the superior vena cava cannulation group. Three patients had femoral vein thrombosis, two (6.6%) patients in the femoral vein group (two nonobstructive thromboses, adherent to the common femoral vein wall) and one (3.0%) patient in the superior vena cava group (nonobstructive thrombosis which developed in the superficial femoral vein) (p = NS). Lower deep extremities thrombosis developed in five (16.7%) patients in the femoral vein group and in five (16%) patients in the superior vena cava group (p = NS). CONCLUSIONS: Femoral vein catheterization with a polyurethane catheter is associated with a lower rate of extremity deep vein thrombosis which is similar to the rate observed after superior vena cannulation in comatose or sedated patients. Femoral vein thrombosis was observed at a rate of 6.6% after femoral vein cannulation and a rate of 3% after superior vena cava cannulation. Given the acceptable rate of this clinically important complication, femoral vein cannulation offers an attractive alternative to insertion via the vena cava in the critically ill.

APACHE↗
PubMed1989

Hydrophilic polyurethane versus autologous femoral vein as substitutes in the femoral arteries of dogs: quantification of platelets and fibrin deposits.

Hydrophilic, microporous polyurethane vascular prostheses displayed good mechanical characteristics and the behaviour in vitro was excellent. The in-vivo results were, however, disappointing. To obtain a better understanding of the phenomena involved in the acute and early thrombosis, we implanted the polyurethane graft in the canine left femoral artery and an autologous femoral vein in the right for 4 and 24 h. At 4 h, one polyurethane graft was totally occluded and the other two were close to complete occlusion; at 24 h, none was patent. On the other hand, all autologous veins were patent. The thrombotic matrix incorporating both platelets and fibrinogen, quantified by labelling, was anchored along the anastomotic lines. This study confirms that polyurethane occlusion is initiated by hyperplastic reaction, but does not explain why.

Animals↗
PubMed1976

Effects of implanted Doppler flowmeters on femoral vein autografts.

Thirteen femoral vein autografts were placed into the corresponding ipsilateral femoral arteries of 8 mongrel dogs. Cuff-type Doppler (ultrasonic) flowmeters were placed around six of the grafts. None of the vessels thrombosed. Blood flow velocities were measured in all vessels up until the time of sacrifice (mean 95 +/- 5 days after surgery) or accidental death (one dog, 49 days after surgery). The only case of graft failure was attributed to infection at the flowmeter site. With this single exception, the vein grafts exhibited uniformity in histological appearance from dog to dog. These data suggest that implantation of properly designed Doppler flow transducers may have clinical applications. This technique permits continuous or intermittent assessment of blood flow characteristics through a graft without additional trauma or cost to the patient. It is free of the many inherent disadvantages of chronically implanted electromagnetic flowmeters and may negate the need in some instances for followup angiographic studies.

Animals↗