One-stage basilic vein tunneled transposition for hemodialysis access

Abstract

The autogenous arteriovenous fistula (AVF) is an access of choice for chronically hemodialyzed patients [1–4], preferred over central venous catheter placement [5]. The AVF’s access vein on the upper extremity can be either the cephalic or basilic vein (BV). The forearm AVF is the first choice. In the case of inadequate, narrow or thrombosed forearm veins, the arm veins can be used to create an AVF. When the favorably located cephalic vein is narrow or thrombosed, the BV remains an alternative [6]. The deep location of BV in the arm makes this vein unsuitable for puncture without superficialization [1, 2, 7]. There are several techniques enabling the use of the deeply located BV, including lipectomy, BV elevation and BV tunnel transposition (BVTT) [1, 2, 7, 8]. Therefore, BV AVF remains an access option for difficult cases, along with central venous catheter placement or prosthetic graft AVF [2]. BVTT is technically more complex than catheter placement or prosthetic graft AVF [5, 9], but has all the advantages of autogenous AVF and forms a long and superficial vein segment suitable for cannulation [7].