Basilic vein transposition to enhance arteriovenous fistula venous outflow: a single-center technical note

To describe the technical feasibility and early clinical outcomes of basilic vein to fistula outflow vein transposition as an autogenous salvage option for malfunctioning forearm arteriovenous fistulas (AVFs) with venous outflow obstruction at the elbow level and a patent basilic vein.

This single-center retrospective technical note reviewed nine patients who underwent basilic vein to fistula outflow vein transposition between December 2023 and March 2026. Clinical indications, reasons for selecting surgical transposition over further endovascular treatment, operative details, time to postoperative dialysis use, complications, reinterventions, and individual access outcomes were summarized descriptively.

The mean age was 67.8 ± 7.2 years; seven patients were male. Hypertension was present in all patients and diabetes mellitus in two patients. The main clinical triggers for intervention were venous hypertension during hemodialysis, thrombotic occlusion of the cephalic outflow vein, and inadequate dialysis blood flow. The mean preoperative basilic vein diameter was 2.0 ± 0.28 mm. After reconstruction, all patients had restoration of a normal access thrill and resolution of abnormal fistula pulsatility, while intradialytic venous hypertension improved compared with the preoperative status. All AVFs were successfully used for hemodialysis within 48 h after surgery. Two patients had wound hemorrhage that resolved after bedside management. During follow-up, five patients required reintervention for restenosis, including PTA and open thrombectomy. No early thrombosis, hematoma, nerve injury, wound infection, clinically significant steal syndrome, or access abandonment occurred during the available follow-up.

In patients with a functioning forearm AVF, preserved arterial inflow, elbow-level venous outflow obstruction, and a suitable basilic vein, basilic vein-to-fistula outflow vein transposition may represent a practical autogenous salvage option. These findings should be interpreted as preliminary technical experience.