The Value of Great Saphenous Vein Harvest in Brachio-Axillary Arteriovenous Fistula for Hemodialysis

Document Type : Original Article

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Department of Vascular surgery, faculty of medicine, Aswan university

Abstract

Background: Autologous arteriovenous fistula (AVF) remains the gold standard for hemodialysis access, offering fewer complications and longer patency. In patients with inadequate upper limb veins, alternative options such as great saphenous vein (GSV) harvest or prosthetic grafts must be considered. This study aimed to evaluate the outcomes of GSV harvest for AVF creation in patients with poor superficial veins, focusing on patency, maturation time, and complications.
Methods: This prospective study included 25 hemodialysis patients with exhausted upper limb veins for AVF. All patients underwent AVF creation using the harvested GSV. Patient characteristics, operative details, graft maturation, patency rates, and postoperative complications were assessed. The primary outcome was the patency rate at 3, 6, and 12 months. Secondary outcomes included maturation time, operative time, hospital stay, and complications such as thrombosis and access failure.
Results: The mean time for fistula maturation was significantly longer in the GSV group (36.66 ± 4.91 days), while the mean operative time was 119.52 ± 10.6 minutes. Primary patency rates at 12 months were 24%, with secondary patency improving to 36%. Thrombosis occurred in 28% of patients by 12 months, and access failure was reported in 28% of cases. Postoperative complications included pseudoaneurysm (32%), hematoma (24%), and bleeding (16%).
Conclusions: GSV harvest for AVF creation is a viable option for patients with inadequate upper limb veins, though it requires longer operative times and has a higher complication rate. Despite this, secondary patency rates were relatively favorable, supporting its use in select patients.

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