The Transposed Femoral Vein Fistula - The Native Choice in Desperate Vascular Access.

Background: This is a review of our experience in creating transposed femoral vein (TFV) fistulas and some of the lessons we have learnt while performing this challenging procedure over the last 5 years. Methods: This is retrospective review of patients who underwent TFV fistula formation between January 2013 and December 2017. Results: Fifteen patients underwent TFV fistula formation with 4 cases being excluded from analysis. Median follow-up was 1.17 years (interquartile range 0.19-3.59 years). Primary and primary-assisted patency rates were 75% and 100% at 6 months, respectively, and 66.7% and 100% at 1 year. Conclusions: Our patient group showed good fistula patency at 1 year and did not experience any incidence of ischemic steal syndrome. We believe this to be due to careful preoperative patient assessment and meticulous surgical technique. Our experience suggests that such procedures should be performed by surgeons with vascular expertise wherever possible to reduce the incidence of complications.