Two-stage combined basilic-brachial vein transposition

Area of Science:

• Vascular Surgery
• Nephrology
• Dialysis Access

Background:

• Arteriovenous fistula (AVF) creation is crucial for long-term hemodialysis access.
• Standard AVF procedures may face challenges due to anatomical variations.
• Optimizing AVF creation techniques is essential for patient outcomes.

Observation:

• A patient presented with a planned two-stage basilic and brachial vein transposition for AV fistula creation.
• During the second stage, a low confluence of the basilic and brachial veins was identified.
• This anatomical variation posed a challenge to the standard surgical plan.

Findings:

• A modified technique involving mobilization and transposition of the brachial vein was successfully employed.
• This adaptation allowed for the creation of a functional arteriovenous fistula despite the challenging anatomy.
• The fistula was subsequently utilized effectively for hemodialysis treatments.

Implications:

• This case highlights an alternative surgical strategy for AV fistula creation in complex anatomical situations.
• The described technique can potentially increase the success rate of fistula creation in challenging cases.
• Vascular surgeons should consider this adaptable approach to maximize successful dialysis access.