Fístula arteriovenosa con elevación de la vena basílica. Reporte de casos / Arteriovenous fistula with basilic vein elevation. Case series

RESUMEN Las fístulas arteriovenosas (FAV) se requieren para hemodiálisis permanente. Las recomendaciones de acceso preferidas son radio cefálica, braquiocefálica, braquio-basilica con elevación o transposición y tunelización. El objetivo de este trabajo fue presentar la experiencia con la creación de FAV con vena basílica elevada. Entre junio 2017 y marzo 2020, se realizaron trece FAV braquio-basílicas con técnica de elevación de acuerdo al registro de cirugías realizadas por la Unidad, siete hombres y seis mujeres. La edad media fue 65,7 años. En el post operatorio temprano hubo hematomas de antebrazo en dos casos, infección de herida en dos casos, así como un caso de edema. En el periodo de seguimiento, tres no maduraron, y tres pacientes fallecieron; mientras que las FAV restantes aún están funcionando. En conclusión, la FAV braquio-basilica con vena elevada es una alternativa en pacientes que ya han agotado otras opciones.

ABSTRACT Arteriovenous fistula (AVF) is necessary for hemodialysis access. The preferred configurations are radial-cephalic, brachial-cephalic, and brachial-basilic with elevation or transposition and tunneling. The purpose of this study was to present our experience for creating arteriovenous fistulae using the elevation of the basilic vein technique. Between June 2017 and March 2020, thirteen brachial-basilic fistulae with elevation of the basilic vein were performed in seven male and six female subjects. Their mean age was 65.7 years. During the early post-op period, there were two cases of forearm hematoma, wound infection in two cases, and edema in one case. During the follow-up period, three fistulae did not have a good progression, and three patients died; the remaining AVFs are still working. In conclusion, brachial-basilic AVF with elevation of the basilic vein is an alternative in patients who have already exhausted other access options.

Free basilic vein flap with sensory nerve for repair of pulp defect of digits / 中华显微外科杂志

Objective:To investigate the effect of free basilic vein flap with sensory nerve in repair of digit pulp defect.Methods:From August, 2017 to December, 2020, 26 thumb and finger pulp defects were repaired with free basilic vein flap with sensory nerve. There were 23 defects of digit pulp, and 3 combined with dorsal soft tissue defect. The sizes of defect area of 11 thumbs and 15 fingers were 3.0 cm×2.0 cm-5.0 cm×3.5 cm. The size of flap was 3.5 cm×2.5 cm-5.5 cm×4.5 cm. All of the digit defects were repaired with free basilic vein flap carrying sensory nerve at the medial side of proximal forearm. All donor sites at forearm were directly sutured. All patients entered follow-up by clinic visit by telephone appointment. The appearance of the flaps was good with satisfactory texture, good pinching and well recovered sensation.Results:All 26 flaps survived in the 3-28 months(13 months in average) of follow-up. The TPD was 6-8 mm (6.8 mm in average). Only linear scars left at the donor sites without obvious discomfort, except 3 cases having in minor bloating. The bloated flaps were repaired 3 months after the primary surgery, and achieved more satisfactory appearances.Conclusion:Free basilic vein flap with sensory nerve is an ideal method to repair defect of digit pulp, especially in the digit pulp composite tissue defect combined with vessel and nerve defect.

Doença cística da adventícia na veia basílica: relato de caso / Basilic vein cystic adventitial disease: case report

Resumo A doença cística da adventícia é uma entidade rara que acomete principalmente a artéria poplítea. A ocorrência em veias é muito rara, e sua etiologia é desconhecida. Clinicamente, apresenta-se como isquemia, trombose ou dor a depender do território acometido. Apresentamos o caso de um paciente masculino jovem referindo nódulo no braço esquerdo. A angiorressonância magnética do membro mostrou lesão cística em contato com a veia basílica, com conteúdo homogêneo e sem realce pós-contraste. Foi realizada ressecção da lesão em bloco com o segmento venoso envolvido. O estudo anatomopatológico foi sugestivo de cisto de adventícia de veia basílica.

Abstract Cystic adventitial disease is a rare entity that most often involves the popliteal artery. It rarely occurs in veins. Its etiology is unknown. Clinically, it presents with ischemia, thrombosis or pain, depending on the vessel affected. Here we present the case of a young male with a nodule in the left arm. Magnetic resonance angiography showed a cystic lesion in contact with the basilic vein, with homogenous content without post-contrast enhancement. The lesion was resected en bloc together with the venous segment involved. The results of microscopic analysis were suggestive of basilic vein cystic adventitial disease.

Relación entre el patrón venoso superficial del antebrazo y las complicaciones de los cateterismos venosos periféricos y centrales en una muestra de niños atendidos en una unidad de cuidados intensivos pediátricos de Santander Colombia / Relationship between surface forearm vein pattern and complications of peripheral and central venous catheterization in a sample of children treated in the pediatric intensive care unit of Santander Colombia

Desde hace varias décadas se han adelantado estudios anatómicos que muestran como las poblaciones en diversos países mantienen una representación de los diferentes patrones venosos superficiales en el antebrazo. Esto contrasta con el concepto arraigado en los textos clásicos de anatomía que mantuvieron la idea de una poca variabilidad de las venas y un predominio del llamado patrón en "M". El presente estudio descriptivo, en niños que ingresaron a la Unidad de Cuidados Intensivos Pediatricos (UCIP) y requirieron acceso venoso en miembro superior, busca determinar si existe asociación entre las venas y el patrón venoso superficial del antebrazo y la necesidad de retirar los catéteres superficiales (bránula y epicutáneo). Se incluyeron 54 pacientes: 23 niñas y 31 niños. Se valoraron las indicaciones de venopunción y el tipo de patrón venoso. Se presentaron 22 cambios en la venopunción principalmente en los patrones II y IV. Pero aunque el patrón IV tuvo un porcentaje de presentación menor comparado con el patrón II, fue el único patrón en el cual se presentó la necesidad de cambiar la venopunción en 3 ocasiones consecutivas. Consideramos de gran importancia darle una aplicación clínica al concepto anatómico de los patrones venosos; fomentar en las escuelas de Enfermería y Medicina la enseñanza de los patrones venosos y sus implicaciones de riesgo, y valorar con estudios posteriores si el patrón tipo IV puede aumentar el riesgo de iatrogenia en poblaciones infantiles.

For several decades there have been advanced anatomical studies showing how populations in different countries maintain a representation of the different surface vein patterns in the forearm. This contrasts with the concept rooted in the classical texts of anatomy that kept the idea of a low variability of veins and a predominance of pattern called "M". This descriptive study in children admitted to the Pediatric Intensive Care Unit (PICU) and required upper limb venous access, seeks to determine whether there is an association between the veins and superficial venous pattern of the forearm and the need to remove the catheter surface (branule and epicutaneous). Fifty-four patients were included: 23 girls and 31 boys. Directed by venipuncture and type of vein patterns were assessed. Twenty-two changes occurred mainly in venipuncture patterns II and IV. But although the pattern IV had a lower percentage compared to the standard presentation II, it was the only pattern which showed the need to change the venipuncture on 3 consecutive occasions. We assign great importance to give a clinical application to the anatomical concept of vein patterns; encouraging nursing schools and those teaching Medicine vein patterns and associated risk implications, and titrate with further studies if the IV pattern can increase iatrogenic risks in pediatric populations.

Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

BACKGROUND AND OBJECTIVES: Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization. In the present study, we evaluated the feasibility of right cardiac catheterization via the antecubital fossa vein in Korean patients. SUBJECTS AND METHODS: The medical records of all patients who underwent right heart catheterization at our hospital between January 2003 and December 2014 were reviewed retrospectively. Right cardiac catheterizations via the antecubital fossa vein and the femoral vein were compared in terms of demographic data (age, sex, weight, height, and body mass index), indications for right cardiac catheterization, and procedural and outcome data (initial success rate, procedure time, compression to ambulation time, and complications). RESULTS: We reviewed 132 cases (antecubital fossa vein approach, n=37; femoral vein approach, n=95). The demographic data, initial success rate (100% vs. 100%) and procedure time (21.6±16.8 min vs. 25.6±12.6 min, p=0.14) were similar in both groups. The antecubital fossa vein group had a shorter mean compression to ambulation time than the femoral vein group (0.0 min vs. 201.2±48.1 min, p<0.01). No complications were observed in either group. CONCLUSION: Our study indicated the ease of performance of right cardiac catheterization via the antecubital fossa vein. Thus, the antecubital fossa vein can be an alternative access site for right cardiac catheterization in Korean patients.

Upper Arm Basilic Vein Transposition for Hemodialysis: A Single Center Study for 300 Cases

PURPOSE: The population of end-stage renal failure patients dependent on hemodialysis continues to expand with an increasing number of patients having an unsuitable cephalic vein or failed radio- and brachio-cephalic fistula. In these patients, the transposed basilic vein to brachial artery arteriovenous fistula (BaVT) provides autologous choice for hemodialysis. The results of basilic vein transposition arteriovenous fistula were assessed. MATERIALS AND METHODS: Three hundred cases of BaVT performed at a single center during the period of January 2005 to December 2011 were reviewed retrospectively. Data including demographics and postoperative complications were collected. Primary and secondary patency rates were determined by using Kaplan-Meier methods. RESULTS: The median age of patients was 57.4±13.1 years, and 154 patients were male. Renal failure was associated with hypertension in 88.7%, and with diabetes in 34.0%. The mean follow-up was 27.4±20.0 (12 to 72) months. There was no operation-related death. Eighteen patients required prosthetic graft interposition because of short vein. Thirty-five postoperative complications developed in 41 patients (148 cases), including thrombosis, stenosis, hematoma, seroma, arm swelling, steal syndrome, infection and aneurysm formation. Primary patency of BaVT was 69%, 60%, 53%, 52%, 44%, and 22% at 1, 2, 3, 4, 5, and 6 years, respectively. Secondary patency was 99%, 97%, 97%, 97%, 95%, and 95%, respectively. CONCLUSION: Chronic renal failure patients with hemodialysis may benefit from BaVT, because of high patency, less radiologic procedure, and less infection rate. The BaVT fistula should be used in preference to polytetrafluoroethylene grafts for secondary access.

Clinical application of basilic vein transposition arteriovenous fistula in hemodialysis patients / 中国综合临床

Objective To investigate the clinical effect of basilic vein transposition arteriovenous fistula in hemodialysis patients.Methods NInety patients with maintenance hemodialysis received in the NO.180 Hospital of the Chinese People's Liberation Army from September 2011 to September 2012 were randomly divided into two groups,and each group of 45 cases.Patients in the observation were given brachial-basilica transposition arteriovenous fistula,while patients in the control group received artificial vascular graft arteriovenous fistula.The fistula maturation time,dialysis blood flow,urea removal index (Kt/V),patency rates and complications were respectively recorded.Results Compared with control group,fistula maturation time,dialysis blood flow,Kt/V and complications rates in observation group were significantly higher((14.4±3.2)weeks vs.(16.1±2.7) weeks,(291.5±33.9) ml/min vs.(252.6±29.8) ml/min,(1.6±0.2) vs.(1.3±0.3);t =4.538,3.984,4.016;P＜ 0.05).Complications (ipsilateral upper limb swelling,thrombosis,venous ectasia and arteriovenous fistula stenosis) incidence were significantly lower than those of control group (2.2％vs.13.3％,2.2％ vs.11.1％,6.6％ vs.17.8％,11.1％ vs.24.4％;x2=5.463,4.972,5.017,3.968;P ＜0.05).Patency rates of observation group in 3 months,6 months,1 year and 2 years were also significantly higher than those of control group (97.8％ vs.93.3％,91.1％ vs.84.4％,88.9％ vs.75.6％,84.4％ vs.68.9％,x2 =5.315,4.238,7.024,5.913;P＜0.05).Conclusion Basilic vein transposition arteriovenous fistula is reliable and effective for hemodialysis patients.It can achieve adequate dialysis and less complications and It is worth of clinical application.

Short Axillary Vein and an Axillary Venous Ladder Formed by Basilic and Brachial Veins – An Anatomical and Clinical Perspective

Knowledge of anatomic variants of veins in the arm and axilla play a key role in planning of successful venous access. Possible anatomic variants of axillary vein, brachial vein and basilic vein and their clinical implications have been well described in the literature. We report a rare case of formation of a short axillary vein associated with complex venous communications between the basilic and brachial veins forming a venous ladder in the axilla, in formalin embalmed male cadaver. Axillary vein was formed in the upper part of the axilla by the fusion of basilic vein and unpaired brachial vein, and it was about 3cm in length. The higher-up confluence of basilic and brachial veins was also associated with presence of three communicating veins between the basilic and brachial veins in the axilla. Knowledge of reported venous variations is very useful during preoperative venous mapping and also for planning and execution of various surgical invasive procedures involving these veins.

Variations of the cubital superficial vein investigated by using the intravenous illuminator / 대한해부학회지

The purpose of this study was to report variations of the cubital superficial vein patterns in the Korean subjects, which was investigated by using venous illuminator, AccuVein. The 200 Korean subjects were randomly chosen from the patients and staff of the Keimyung University Dongsan Medical Center in Daegu, Korea. After excluding the inappropriate cases for detecting venous pattern, we collected 174 cases of right upper limbs and 179 cases of left upper limbs. The superficial veins of the cubital fossa were detected and classified into four types according to the presence of the median cubital vein (MCV) or median antebrachial vein. The type II, presenting the both cephalic and basilic vein connected by the MCV, was most common (177 upper limbs, 50.1%). Although the most common type in male and female was different as type I (108 upper limbs, 49.3%) and type II (75 upper limbs, 56.0%), respectively, statistical significance was not detected (P=0.241). The frequency of the each types between right and left upper limbs was also not different (P=0.973). Among 154 subjects who were observed the venous pattern in the both upper limbs, 76 subjects (49.3%) had the same venous pattern. Using AccuVein to investigate the venous pattern has an advantage of lager scale examination compared to the cadaver study. Our results might be helpful for medical practitioner to be aware of the variation of the superficial cubital superficial vein.

Medial antebrachial cutaneous nerve: anatomical relationship with the medial epicondyle, basilic vein and brachial artery / Nervio cutáneo antebraquial medial: relación anatómica con el epicóndilo medial, vena basílica y arteria braquial

Medial antebrachial cutaneous nerve (MACN) courses in the medial arm to provide sensory innervation to the medial forearm. Its anatomy has been partly described since data regarding its branching pattern and distances to adjacent landmarks are still lacking. The purpose of this study was to provide morphometric anatomy of the MACN with comparisons between sides and sexes. Ninety-six upper extremities from 26 males and 22 females were dissected. We found that up to 5 branches of MACN pierced the deep fascia with the maximum of 4 reaching the interepicondylar line (IEL). Presence of 2 and 3 branches was found in the majority of cases (> 80%). The distances from these branches to the landmarks varied considerably. In case of no branch, the mean distances to the medial epicondyle (ME) and brachial artery (BA) were approximately 1.5 cm while those to the basilic vein (BV) were 0.7 cm in both sexes. Regardless of the branching pattern, the MACN could pass over or close (within 0.5 cm) to the ME, BV and BA. Asymmetry in the branching pattern was found in 50% of specimens. Sex but not side differences were observed in some measurement parameters. These data are crucial for not only localizing the MACN during nerve block and graft harvest but also avoiding the nerve injury during surgical procedures.

El recorrido del nervio cutáneo antebraquial medial (NCAM) proporciona la inervación sensorial medial del antebrazo. Su anatomía se ha descrito en parte, porque los datos relativos a su patrón de ramificación y distancias a puntos de referencia adyacentes son insuficientes. El propósito de este estudio fue proporcionar datos morfométricos sobre la anatomía del NCAM, comparando entre lados y sexos. Se disecaron 96 miembros superiores de 26 hombres y 22 mujeres. Se encontró que 5 ramos del NCAM traspasaron la fascia profunda y llegaron 4 hasta la línea interepicondilar (LIE). Presencia de 2 y 3 ramos se encontró en la mayoría de los casos (>80%). Las distancias de estos ramos a los puntos anatómicos variaron considerablemente. En caso de ausencia de ramos, la distancia medial al epicóndilo medial (EM) y arteria braquial (AB) fueron de aproximadamente 1,5 cm, mientras que a la vena basílica (VB) fueron 0,7 cm en ambos sexos. Independientemente del patrón de ramificación, el NCAM podría pasar sobre o cerca (a menos de 0,5 cm ) del EM, VB y AB. Asimetría en el patrón de ramificación se encontró en 50% de las muestras. Diferencias en algunos de los parámetros de medición se observaron según sexo, pero no por lado. Estos datos son relevantes para localizar el NCAM durante el bloqueo del nervio y la toma de injertos, sino también para evitar la lesión del nervio durante los procedimientos quirúrgicos.

Venas mediana cefálica y mediana basílica: ¿por qué su exclusión de terminologia anatomica? / Median cephalic and median basilic veins: why their exclusion from terminologia anatomica?

Numerosos artículos han descrito la distribución venosa superficial de la fosa cubital. Estas venas tienen importancia anatómica y clínica y son de interés para anatomistas, cirujanos y enfermeras. Las venas mediana cefálica y mediana basílica son productos de la división de la vena cefálica del antebrazo y ambas drenan en las venas cefálica accesoria y basílica, respectivamente. Nomina Anatomica consideraba a las venas mediana basílica y mediana cefálica, lo que permitía hacer una descripción anatómica precisa, clara y entendible de ellas. Creemos necesario incluir nuevamente los términos de vena mediana basílica y vena mediana cefálica en Terminologia Anatomica, los que fueron excluidos por el Programa Federativo Internacional de Terminología Anatómica (FIPAT).

Numerous articles have described the distribution of superficial veins in the cubital fossa. These veins have anatomic and clinical importance and are of interest to anatomists, surgeons and nurses. The median cephalic and median basilic veins are the product of the division of the cephalic vein of the forearm. Both veins drain into the cephalic vein accessory and basilic vein, respectively. Nomina Anatomica considered the median cephalic vein and median basilic vein, which has allowed a precise, clear and understandable anatomical description. We need to include the terms median cephalic and median basilic veins in Terminologia Anatomica, terms excluded by the Federative International Program for Anatomical Terminology (FIPAT).

Distribución de los patrones venosos de la fosa cubital en una muestra de personas nacidas en el departamento de santander, Colombia / Distribution pattern of the veins of the cubital fossa in a sample of people born in the department of santander, Colombia

Se determinó la frecuencia de los patrones venosos superficiales del miembro superior en una muestra de 885 personas (438 hombres y 447 mujeres) nacidas en el Departamento de Santander, Colombia de acuerdo a la clasificación propuesta por del Sol et al. El patrón que predominó fue el I con 524 casos (30%) seguido del patrón III con 451 casos (26%). El patrón I fue el más frecuente tanto en el miembro superior derecho con 286 casos (32%) como en el miembro superior izquierdo con 238 casos (27%). En hombres el patrón predominante fue el I con 307 casos (35%) seguido del patrón II con 228 casos (26%). En mujeres el patrón predominante fue el III con 367 casos (41%) seguido del patrón I con 217 casos (24%). El patrón en "M clásica" tuvo una frecuencia similar en hombres y mujeres con 8%.

We determined the frequency of superficial vein patterns of the upper limb in a sample of 885 people (438 men and 447 women) born in the department of Santander, Colombia according to the classification proposed by del Sol et al. The predominant pattern was I with 524 cases (30%) followed by pattern III with 451 cases (26%). Pattern I was the most prevalent in both the right arm with 286 cases (32%) and in the left upper limb with 238 cases (27%). In men, the pattern I was predominant with 307 cases (35%) followed pattern II with 228 cases (26%). In women the predominant pattern III was with 367 cases (41%) followed the pattern I with 217 cases (24%). The pattern in "M classic" frequency was similar in men and women with 8%.

Arteriovenous Fistula Creation through Basilic Vein Transposition in an Upper Extremity

PURPOSE: Autogenous arteriovenous access for chronic hemodialysis is recommended by the National Kidney Foundation- Dialysis Outcomes Quality Initiative practice guidelines. A transposed basilic vein to brachial artery arteriovenous fistula provides secondary vascular access for hemodialysis we assess outcomes of basilic vein transposition in arteriovenous fistula in this retrospective series. METHODS: We performed a retrospective review of 81 patients undergoing basilic vein transposition (BVT) in the Soonchunhyang University College of Medicine between January 2000 and December 2006. Age, sex, etiology of end-stage renal disease, and complications were tabulated. Primary and secondary patency rates were determined using Kaplan-Meier methods. RESULTS: The average age was 58 years old and 43 patients were male. Renal failure was associated with hypertension in 59 patients (73%), diabetes in 30 patients (37%), and BVT was the primary access procedure in 19 patients (23%). Follow-up was between 12 to 84 months. There was no operation-related deaths. Seven patients required prosthetic graft interposition because of shortness of the basilic vein. Primary and secondary patency rates were 74% and 93%, respectively, at 1 year, and 73% and 87% at 2 years. Thirty five postoperative complications developed in 21 patients, including thrombosis (1), proximal vein stenosis (17), arm swelling (1), central vein stenosis (10), bleeding with hematoma (1), wound seroma (2), steal syndrome (2) and aneurysm (1). The seven patients who required subsequent prosthetic grafting for a failed basilic vein arteriovenous fistula had an ipsilateral procedure. CONCLUSION: BVT arteriovenous fistula techniques provide a good patency rate. The complication rate, although high, is lower than that reported for PTFE grafts. Chronic renal failure with hemodialysis patients might benefit from BVT, because of long patency, less radiologic procedure, and lower infection rates. The BVT fistula should be used in preference to PTFE grafts for secondary access.

Basilic Vein Transposition as a Salvage for Failed Vascular Access for Hemodialysis

PURPOSE: Maintenance of a functioning vascular access in patients on hemodialysis is very important. To salvage patients with previous access complications, we performed basilic vein transposition in the upper arm or forearm. The purpose of this study was to evaluate the efficacy of basilic vein transposition in cases with hemodialysis graft complications. METHOD: Between March 2004 and August 2007, 11 patients received a basilic vein transposition (BVT) arteriovenous fistula as salvage for failed autogenous or prosthetic vascular access. The medical records and dialysis records were reviewed retrospectively. RESULT: The mean age was 60 (41~71) years and seven patients were male. The most common cause for the renal failure was diabetes in five cases. Upper arm BVT was performed in three patients and forearm BVT in another eight patients. There was no maturation failure. The mean time to maturation time was 45+/-15.5 days. The mean follow-up period was 14.5 months. During this period, two patients developed stenoses that were treated by balloon angioplasty, and two patients died with a patent fistula. The cumulative primary patency rate was 70%. There was no failed fistula during the follow up period. CONCLUSION: Autogenous BVT is a feasible salvage operation for failed vascular access. A BVT should be considered in complicated cases and as primary vascular access.

Autologous Arteriovenous Fistula Formation with Basilic Vein Transposition of Forearm

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.

Autologous Arteriovenous Fistula Formation with Basilic Vein Transposition of Forearm

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.

Brachio-basilic Arteriovenous Fistula Using Transposed Basilic Vein: An Alternative Vascular Access for Hemodialysis

PURPOSE: Effective hemodialysis for a patient with end-stage renal disease (ERDS) is dependent upon a durable, low-morbidity vascular access. Although It is generally agreed that the distal radiocephalic fistula originally discribed by Brescia and Cimino is the most effective primary access constrruction, no consensus exists regarding primary and secondary alternatives for patients with inadequate of failed rediocephalic prodedures. Many options are available, but the relative value of these alternative operations is unclear. Therefore the place of the basilic vein in secondary acccess construction needs to be assessed. We evaluated if the basilic vein can be used to construct a durable, low-morbidity access. METHODS: A native brachio-basilic arterio-venous fistula with superficial transposition has been performed, for lack of usuable vein on 54 forearm in 47 patients from August 1995 to October 1999 (Male: 15, female: 32) with mean age 51 years (26 to 70 years). RESULTS: The main cause of renal insufficiency were: diabetes 27 (57.4%), hypertensive 19 (40.4%), renal tuberculosis 2 (4.3%) and renal cyst 1 (2.1%). The waiting period before vascular access puncture has been 28 6 days. Eight (17.0%) stenosis has been detected and, forearm and/or hand edema occured in three (6.4%); thrombosis in two (4.3%); bleeding in two (4.3%); pseudoaneurysm in one. Through the follow-up periods of 50 months, the primary patency was 80.9% at 12 months and 78.7% at 24 months. CONCLUSION: The brachio-basilic fistula with superficial transposition of basilic vein is a valuable vascular access for diabetes, female old patients, and can remain an alternative method for even younger patients by avoiding the installation of artificial graft after failed forearm arteriovenous fistula.

Ulnar Artery-Forearm Basilic Vein Arteriovenous Fistula: Is It an Acceptable Option for Increasing Use of Autogenous Arteriovenous Fistula?

PURPOSE: An Ulnar artery-forearm basilic vein arteriovenous fistula (UBAVF) is not often used for hemodialysis access because the vessels are anatomically deep structures, the basilic vein is often not well developed, and access to this vein for subsequent puncturing is difficult, and the arm position is uncomfortable because of its position on the medial side of the arm. To evaluate the role of this fistula in selected patients with no other accessible autogenous cephalic veins and failed autogenous vein fistula, we conducted this study. METHODS: From March 1998 to August 1999, 164 arteriovenous fistula (AVF) formations were done in 151 patients who required chronic hemodialysis in Seoul and Chungnam National University Hospitals by one surgeon. Among them, ten (6.1%) UBAVFs were included. UBAVF formation could be considered in all cases of primary AVF and failed AVF, but the following criteria were necessary for selection of ulnar-basilic fistula: (1) No accessible forearm cephalic veins on either sides, (2) Presence of pulsation of radial, ulnar arteries and a normal Allen test, (3) Luminal diameter of the basilic vein greater than or equal to 3 mm and confirmation of patency of the proximal venous outflow by manual percussion. Single incisions were used in the majority of cases, and longer maturation time before initiation of hemodialysis was recommended compared with other autogenous vein fistulas. One- and two-year primary patency rates and the early failure rate were analyzed and compared with those for vein fistulas of the other sites. Satisfaction of patients with this fistula was evaluated by direct or phone communication with the patients and dialysis nursing personnel. RESULTS: Mean age was 45.1 years (21-67 years) and male to female ratio was 6:4. Four cases (40%) were done as a primary AVF, and six were as a second or more AVF. Mean follow-up period was 15.3 months, and no major complications occurred, except for one case of early thrombotic occlusion. Difficulty of needle can nulation by dialysis nursing personnel and uncomfortable arm positioning during hemodialysis werenegligible. Early failure occurred in one case and a total of three fistulas failed during the follow-up period. One-and two-year primary patency rates of UBAVF were 78.8% and 67.5%, respectively. There were no statistically significant differences in patency rates between UBAVF and other autogenous vein fistulas during the same period. CONCLUSION: In my experience, UBAVF in selected patients demonstrated a low early failure rate, an acceptable patency rate, and minimal complications. Difficulty of needle cannulation and uncomfortable arm positioning during hemodialysis were minimal, but agreement and education about postoperative discomfort, even planning of vein transpositions, must be considered. In addition, because of location in the forearm, preservation of more proximal vasculature for future hemodialysis access procedures was possible. I recommend selective use of this fistula to increase the use of autogenous vein fistula and to maximize options for hemodialysis access while reducing the dependency on synthetic graft fistula.