Basilic elevation transposition may improve the clinical outcomes for superficialization of basilic arteriovenous fistula veins

Wang, Shouwen; Wang, Michele S; Jennings, William C.

doi:10.1016/j.jvs.2016.10.081

Cited by 24 publications

(28 citation statements)

References 29 publications

(92 reference statements)

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“…During the maturation process of some AVFs, elongation can occur in addition to dilation. While we did not encounter any significant elongation in our cohort, moderate straightening can be performed with this technique by orienting the outflow vein at the most lateral aspect of the skin flap or creating a lateral pouch, if necessary, as described by Wang et al 6 for their basilic elevation transposition technique. If there is excessive length, part of the excess vein can be resected and an end-to-end anastomosis can be created.…”

Section: Surgical Techniquementioning

confidence: 73%

Technical note: An alternative method for AV access superficialization

Fontenot

Illig

2020

J Vasc Access

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Introduction: An arteriovenous fistulae for dialysis access is only functional if superficial enough for reliable cannulation. We describe a previously unreported technique to superficialize arteriovenous fistulae too deep for reliable cannulation. Method: The path of the fistula is marked using ultrasound, and three to four transverse incisions are made along this path. The subcutaneous tissue is separated from the dermis over this entire area. The fistula is then accessed through transverse incisions and by dividing the overlying adipose tissue. The mobilized vein is then “trapped” directly under the dermis by closing the superficial fascia and adipose tissue beneath it and using this tissue to elevate the fistula. No anastomotic revisions are necessary, and moderate straightening can be performed. Results: We have performed this procedure on 20 patients with 100% technical success. One fistula had thrombosis within 8–10 weeks of the superficialization procedure and one patient refused access due to pain, but all other fistulas were successfully cannulated. Two patients were lost to follow-up, and one patient developed skin breakdown in the area of the flap which delayed cannulation. Our 3-month patency was 94.4% with a functional patency, defined as a clinically patent fistula successfully being used for hemodialysis, of 87.5%. Conclusion: The technique described allows elevation of the vein to the level of the dermis without division and re-anastomosis or re-tunneling, through several small incisions maintaining virgin skin and normal contour for easier cannulation.

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Section: Surgical Techniquementioning

confidence: 73%

Technical note: An alternative method for AV access superficialization

Fontenot

Illig

2020

J Vasc Access

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“…Wang et al recently compared two-stage elevation with two-stage transposition and found that two-stage elevation is a reliable approach because of better primary patency and reduced need for salvage interventions to the fistulas. 36 ) The interval between the first and second operations is varied from 3 to 8 weeks depending on the maturation criteria of the basilic vein.…”

Section: Surgical Techniquementioning

confidence: 99%

Transposed Brachial–Basilic Arteriovenous Fistula for Vascular Access in Japan

Deguchi

Sato

2018

Annals of Vascular Diseases

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As more than 320,000 patients are currently receiving hemodialysis treatment in Japan, the creation and maintenance of hemodialysis access is a major concern. The national guidelines recommend autogenous arteriovenous hemodialysis, and the brachial–basilic arteriovenous fistula has been the focus of attention, because the need for secondary, tertiary, or even more vascular access is growing. Although favorable results have been reported in terms of patency and access-related complication, this fistula involves various unsolved or controversial issues, with limitations including complex procedures, which might contribute to the lower prevalence at this point in Japan. This review addresses those issues and discusses the role of fistula in Japan.

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“…A basilic vein transposition elevation procedure in the upper arm was performed as previously described. 4,5 All vein branches were ligated and divided while fibers of the median cutaneous nerve were gently separated longitudinally to allow elevation of the vein into a superficial position, anterior to the incision. 6 A video of the vein elevation procedure is available for review.…”

Section: Technical Notementioning

confidence: 99%

“…We report our successful use of basilic vein transposition in the upper arm as an option for establishing a safe and functional access while preserving the advantages of a distal wrist anastomosis and offering a larger access target with a much more reliable location for AVF cannulation. 4…”

Section: Introductionmentioning

confidence: 99%

Upper arm basilic vein elevation as a solution for forearm ulnar-basilic arteriovenous fistulae with cannulation problems

et al. 2018

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Ulnar-basilic arteriovenous fistula is an alternative option when a radiocephalic arteriovenous fistula is not feasible. We review our technique of basilic vein transposition in the upper arm for difficult to puncture forearm ulnar-basilic non-transposed arteriovenous fistulae. Technical note: Three patients were referred for forearm ulnar-basilic arteriovenous fistulae with difficult cannulation where the forearm basilic vein was left in situ (non-transposed). Surgeon performed ultrasound examination confirmed a patent arteriovenous fistula with adequate diameter and flow, draining to the basilic vein in the forearm and into the upper arm. Recurrent new and resolving hematomas were present surrounding the forearm basilic vein resulting from difficult cannulation issues and problems maintaining needle position due the posterior-medial ulnar-basilic arteriovenous fistula position and mobility of the non-transposed forearm basilic vein. A basilic vein transposition elevation procedure was performed in the upper arm starting at the level of the elbow to a few centimeters below the axilla. Branches of the dilated basilic vein were ligated, the median cutaneous nerve was preserved, and the vein was elevated from its native position to a superficial and anterior location. Although difficult, dialysis access had been continued in the forearm during a brief period and none required catheter placement. Reliable dialysis access was successfully initiated using the newly transposed basilic vein in the upper arm 3-4 weeks after the procedure, maintaining arterial inflow based on the original ulnar-basilic arteriovenous fistula anastomosis at the wrist. None of the patients required further interventions with follow-up of 8, 15, and 22 months.

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Basilic elevation transposition may improve the clinical outcomes for superficialization of basilic arteriovenous fistula veins

Abstract: BET is a reliable approach that yields a high cumulative fistula survival rate. Compared with BTT, BET is associated with improved basilic vein primary patency and reduced need for endovascular interventions.

Cited by 24 publications

References 29 publications

Technical note: An alternative method for AV access superficialization

Technical note: An alternative method for AV access superficialization

Transposed Brachial–Basilic Arteriovenous Fistula for Vascular Access in Japan

Upper arm basilic vein elevation as a solution for forearm ulnar-basilic arteriovenous fistulae with cannulation problems

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