Basilic Vein Transposition Fistula

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Upper arm basilic vein transposition fistula is an excellent tertiary autologous vascular access after radio cephalic and brachio cephalic fistula. If the basilic vein is smaller than 2 5 mm failure is common.

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It has been observed empirically that basilic transpositions done after previous access in the same arm are more successful.

Basilic vein transposition fistula. The basilic vein above a forearm graft or fistula may have been built up over time from receiving increased blood flow. A total of 375 brachiobasilic arteriovenous fistulas were constructed with superficialization of the basilic vein technique. Basilic vein transposition was considered eligible when the basilic vein had a minimal diameter of 3 mm and was nonstenotic and nondiseased with a minimal length of 15 cm.

Because of nkf doqi there has been a resurgence of enthusiasm in placing primary av fistulas and subsequently more interest in alternative autogenous fistula techniques. Veins of seven eight ten millimeters or more are frequently seen in the outflow of forearm accesses. The purpose of this study was to present and discuss the technique of superficialization of the basilic vein in brachiobasilic arteriovenous fistula with long term results of 350 cases.

The basilic vein was then transected ligated at the most distal end and flushed with heparinized saline while noting for any evidence of stenosis or obstruction to the flow. The basilic vein transposition arteriovenous fistula bvt described in 1976 by dagher et al 2 reviewed again in 1986 3 is enjoying a renewed popularity as surgeons strive to increase autogenous fistula creation rates. The basilic vein has been recognized as a suitable vein for creating a native transposed fistula to the brachial artery.

A one stage basilic vein transposition usually matures if the basilic vein is larger than 3 5 mm but a two stage basilic vein transposition should be constructed if the vein is between 2 5 and 3 5 mm. Less attention has been given to the brachial vein as a conduit for dialysis access. Background primary patency 1 year.

The kidney disease outcome quality initiative kdoqi guidelines have recommended that in patients with chronic kidney disease autogenous radiocephalic or alternatively brachiocephalic fistula should be the preferred types of vascular access 1 2 in case the cephalic vein or the radial artery is not suitable for creating an autogenous fistula or if such accesses fail the use of the basilic vein transposition bvt fistula has been suggested followed by prosthetic grafts. For creation of a ptfe loop a suitable elbow vein with a minimal diameter of 4 mm was considered necessary. 50 to 90 secondary patency 1 year.

47 to 96 maturation rate. The distended vein is then gently draped over the upper arm in an arc and the future course of the transposed vein is marked on the skin.

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Fig 5 10 Autologous Brachiobasilic Arteriovenous Fistula A The Brachial Peritoneal Dialysis Anatomy And Physiology

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