Femoral Vein Translocation for Complex Hemodialysis Access

Vascular access is difficult in patients without suitable arm veins and prior graft infections. The use of femoral vein translocation for complex hemodialysis access may be associated with low infection rates and high patency rates. The largest case series in the literature only consists of 30 cases. The objective of this study is to determine the infection incidence, primary patency, primary-assisted patency, and secondary patency rates among femoral vein translocations. A retrospective chart review was performed on all patients who underwent femoral vein translocation by a single vascular practice over a 10-year period from 2013 to 2023. Study variables included length to last follow-up (months), prior access, prior graft infection, comorbid conditions, primary patency, primary-assisted patency, secondary patency, postoperative steal syndrome, postoperative graft infection, postoperative harvest site complication, and postoperative compartment syndrome. A total of 131 femoral vein translocations were performed over the 10-year period; 126 patients (46% male, 68% female) with a mean age of 52 ± 14 years and a mean body mass index 29 ± 8 had follow-up data and were included for analysis. The median follow-up was 46 months (interquartile range, 19-72 months). The mean number of prior permanent accesses was 2 (range, 0-5). Forty-eight percent of patients had prior graft infections. The primary, primary-assisted, and secondary patency rates were 66%, 93%, 98%, respectively, at 6 months; 42%, 84%, and 96% at 12 months; 23%, 68%, and 91% at 24 months; 11%, 54%, and 86% at 36 months; and 10%, 47%, and 78% at 48 months (Figure). The incidence of postoperative steal syndrome requiring an additional procedure was 15%. The incidence of postoperative access infection requiring access excision was 5%. The incidence of postoperative harvest site complications requiring an additional procedure was 19%. Three patients developed compartment syndrome postoperatively, requiring fasciotomy. Femoral vein translocation is associated with low infection rates and high long-term patency rates. Femoral vein translocation does have a significant risk for postoperative steal syndrome and thigh complications; however, it is a viable option for patients with repeated graft infections.