Basilic vein transposition is a feasible and a good method to make avf with autogenous vein. An incision was made through the subcutaneous tissue along the side of the basilic vein.
The basilic vein was transposed over the left biceps and anastomosed to the brachial artery.
Basilic vein transposition procedure. The skin was closed using 4 0 monocryl suture for a subcuticular stitch. Superficialization of the basilic vein technique is a logical alternative method of the basilic vein transposition. The conventional bvt requires long incision over the medial aspect of the arm to dissect the basilic vein up to axillary vein.
The basilic vein was pretty well mobilized and anastomosed to the brachial artery in the past. Upper arm basilic vein transposition fistula is an excellent tertiary autologous vascular access after radio cephalic and brachio cephalic fistula. The medial antebrachial cutaneous nerve fig.
2 is carefully protected. Primary patency of basilic vein superficialization fistulas was 92 78 64 and 54 at 1 2 3 and 4 years respectively. Operation time was around 1 hours.
The subcutaneous tissue was then reapproximated with 3 0 vicryl sutures in interrupted fashion. Secondary patency was 93 81 66 and 56 at 1 2 3 and 4 years respectively. 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.
Patients with a prior history of access surgery and a smaller basilic vein diameter were more likely to undergo a two stage bbavf procedure one stage procedure had more arm swelling more. In one stage procedures the basilic vein is usually mobilised through a single arm incision along the course of the basilic vein fig. Transpositioned basilic veins were well matured enough to dialysis.
Small incision can be applied to basilic vein transposition which can be less painful and more comfortable to the patients. The bed of dissection of the basilic vein was then treated with fibrin sealant. It is then cut in the cubital fossa and transposed into the subcutaneous tissue by multiple small incisions to perform the end to side basilic vein brachial artery anastomosis.
The two stage procedure is most beneficial when the upper arm veins are of borderline size 2 5 3 5 mm. If necessary the incision is extended transversely to the antecubital fossa. Particular attention was made to identify drainage patterns of previous avfs radio cephalic and brachio median cubital leading to enlargement of the basilic vein in order to exclude these patients from the study and also to completely map the basilic vein in order to choose the incision site.