Minimally Invasive Basilic Vein Harvest for Arteriovenous Fistula Transposition using a Laryngoscope

Abstract

The standard lengthy surgical incision used for basilic vein arteriovenous fistula (AVF) transposition is associated with significant discomfort, scarring and risk of wound complications. Minimally invasive vein dissection using a laryngoscope is an inexpensive alternative which has been successfully used for saphenous vein harvesting and which we have applied to the basilic vein for laryngoscopic-assisted AVF transposition (L-AVF/T). During this technique, the basilic vein is mobilized through two small incisions, one in the axilla and the second just proximal to the cubital fossa. Ultrasound examination is used to map the location of the largest distal venous branch, either the forearm basilic vein or the median cubital vein. An important element of exposure is incising the superficial investing fascia longitudinally over the vein, allowing the working space to expand. L-AVF/Ts were constructed in 47 patients during a 20 month time period. Mean age was 62 (18-87) years. Twenty-five (53%) patients were women, sixteen (34%) were obese and twenty-eight (60%) were diabetic. All veins were successfully harvested and there were no neurologic injuries. Primary and cumulative patency rates were 80% and 92%, respectively, at one year with follow-up ranging between 1-20 months (mean = 4 months). Minimally invasive dissection of the basilic vein for vascular access transposition using laryngoscopic assistance is safe, reliable and cost efficient with good short-term patency and functional outcomes.