© 2011 Wichtig Editore - ISSN 1129-7298 J Vasc Access ( 2011; 3):253-257 12 - 253 DOI: 10.5301/JVA.2011.6387 ORIGINAL ARTICLE MATERIAL AND METHODS Patient 1 A 79-year-old male patient with end-stage renal dis- ease had required hemodialysis for 8 years. The patient was neither diabetic nor obese. Past history revealed sev- eral AVF access operations in both upper arms. On physi- cal examination, he had palpable pulses over the dorsalis pedis arteries, and his ankle-brachial index (ABI) was esti- mated to be 1.0 bilaterally. Two longitudinal, tandem incisions separated by a skin bridge were performed parallel to the medial border of the sartorius muscle, and the SFV segment was mobi- lized up to the adductor canal, with ligation of all small tributary branches, up to the level of the common femoral vein (CFV), sparing the profunda femoral vein represent- ing the main collateral leg outflow. A 6-mm PTFE (Gore Intering Vascular Graft) was anastomosed end-to-side to the common femoral artery and positioned laterally, su- perficial to the sartorius muscle and lying deep in the INTRODUCTION Angioaccess in the lower limb is currently gaining in- creased attention, since an increasing number of end-stage renal disease patients need a reliable and durable arterio- venous (AV) access after failure or exhaustion of multiple upper extremity vascular access sites. Several methods for lower-extremity AV access for hemodialysis have been described, ranging from placement of permanent femoral catheters to the construction of autologous and prosthetic AV fistulas (AVFs) (1, 2). Among these, superficial femo- ral vein transposition (tSFV) is associated with better pri- mary and secondary patency rates than femoral synthetic grafts, as well as lower infection and consequent access loss rates, at the expense of more frequent postoperative ischemia, due to steal syndrome (1). The aim of this paper is to present our primary experi- ence with 3 cases of composite tSFV-polytetrafluoroethyl- ene (PTFE) loop grafts for lower limb access, focusing on the pathophysiology of flow due to the interposition of a PTFE segment. Composite PTFE-transposed superficial femoral vein for lower limb arteriovenous access Efstratios I. Georgakarakos, George S. Georgiadis, Nikolaos G. Schoretsanitis, Konstantinos C. Kapoulas, Miltos K. Lazarides Department of Vascular Surgery, University Hospital of Alexandroupolis, Demokritos University, Alexandroupolis - Greece ABSTRACT Purpose: We report our experience in creating a composite loop of transposed superficial femoral vein (tSFV) and polytet- rafluoroethylene (PTFE) synthetic graft for lower limb access. The indication for surgery was exhaustion of access sites in both upper limbs. Methods: Surgery was performed on 3 male patients. All patients had an ankle brachial index ≥0.9. The SFV was mobilized up to adductor canal, with ligation of all small tributary branches, up to the level below the profunda femoral vein, then tunneled medially to the skin. A 6-mm PTFE graft was tunneled laterally, deep in the subcutaneous plane in loop fashion to the end of the tSFV, where a beveled end-to-end anastomosis was created. Results: The blood flow in both fistulas increased gradually to 0.7-1.3 l/min postoperatively. No clinical manifestation indica- tive of lower limb ischemia, lymphorrhea, or infection was documented. No signs related to chronic venous hypertension were noticed. Conclusions: Our initial experience shows that the creation of a composite PTFE-tSFV conduit is a promising technique, since it can be constructed without compromising the distal perfusion, and without infectious complications. Key words: Arteriovenous fistula, Composite graft, Hemodialysis, Superficial femoral vein, Transposition Accepted: December 22, 2010 JVA_10_1101_GEORGAKARAKOS