Forearm Basilic Vein Transposition: A Video Presentation to an Underutilized Option for Autogenous Hemodialysis Access
John Futchko MD, Larry Scher MD
Montefiore Medical Center, Bronx, NY
Patients requiring hemodialysis provide challenges to the surgeon attempting to create durable vascular access. Although algorithms have been established to prioritize autogenous access, the use of forearm basilic vein is an often overlooked and underutilized option. We explore the use of forearm basilic vein transposition (BVT) as an excellent alternative for hemodialysis access and discuss patient selection and operative techniques via video presentation.
Prior to surgical intervention, appropriate physical examinations and duplex ultrasound imaging should be performed to determine adequate basilic vein diameter (>3mm), radial artery caliber and patency, and any possible anatomic variation or central venous obstruction. The vein and the artery, as well as the course of the subcutaneous tunnel, should be marked prior to incision. Exposure of the basilic vein can be performed either with continuous or skip incisions from the antecubital fossa to the wrist. A separate incision is used to expose the radial artery. The vein is then mobilized through ligation of side branches, ligated distally, and marked to prevent kinking. An anterolateral subcutaneous tunnel is created with a 6mm Kelly-Wick tunneler, and the vein is passed though taking care to maintain orientation. End-to-side anastomosis can then be performed to the radial artery.
Forearm BVT is an infrequently considered option for hemodialysis access. Clinical practice guidelines published by the Society for Vascular Surgery describe this procedure as an important component of the algorithm designed to maximize the use of autogenous access procedures. Excellent outcomes are highly dependent on patient selection and excellent surgical technique. In many cases, forearm BVT provides an autogenous option that preserves upper arm veins for later use.
Transposition of the forearm basilic vein is an excellent but underutilized selection for hemodialysis access in carefully selected patients. With satisfactory outcomes and straightforward operative technique, the forearm BVT should not be overlooked due to lack of familiarity, but rather remain a practical surgical option for vascular surgeons.
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