Autologous Arteriovenous Loop Fistula in the Forearm With Transposition of a Matured Forearm Cephalic Vein

Abstract

A 61 year old dialysis patient presented with thrombosed brachiocephalic arteriovenous fistula in the left arm after multiple revisions. On clinical examination it was noted that the patent brachiocephalic anastomosis (arrowhead) was still draining into a considerable length of dilated cephalic vein in the forearm (presenting bruit). Under local anaesthesia a sufficient length of the cephalic vein was dissected free and mobilised (Panel A) to loop back (Panel B, dotted line) for an end to end anastomosis to the basilic vein in the cubital fossa (Panel B, arrow). The presented technique avoids any artificial conduit and spares the brachial site for future interventions.