A modified technique of delayed basilic transposition - initial results

The radiocephalic wrist fistula remains the "gold standard" for primary vascular access placement according to NKF -DOQI guidelines. However, liberal inclusion criteria for dialysis therapy, as well as increasing longevity and prevalence of diabetes, have led to an increased number of patients with distal vessels unsuitable for vascular access creation. Another available location, and one used with increasing frequency, is the anterior cubital fossa. Arteriovenous anastomoses in this location leads to the development of two possible vascular accesses: cephalic and basilic. The basilic vein needs to be transposed to the anterior aspect of the arm. However, this procedure is technically difficult and carries a high risk of complications, often associated with axial torsion or kinking of the transposed vein during placement in the subcutaneous tunnel. The authors propose a simple technical modification which minimizes the risk of these complications. The main advantage is the prevention of axial torsion and kinking, as well as avoiding venous stenosis by transecting the vein at its widest point.