Repositioning of the basilic vein and superficial femoral artery for chronic hemodialysis

Abstract

Suitable access to the circulation for chronic hemodialysis is usually provided by the external silastic shunt [1] or the subcutaneous arterio-venous fistula [2].Occasionally autologous saphenous vein grafts [3] or repositioning of the superficial femoral artery have been used [4–6].We now present an additional technique: superficializing the basilic vein for use as a site.This method can be used in combination with repositioning of the femoral artery to provide both pull and return access to the circulation.Chronic hemodialysis is thus made possible in a patient who lacks major accessible veins and who has a small superficial femoral artery. Under general anesthesia, a 13cm incision is made in the medial groove between biceps and triceps muscles.The basilic vein is dissected free, tributaries are ligated, and the vein is raised to a superficial position one cm lateral to the incision.Subcutaneous tissue is then closed beneath the vein using interrupted catgut sutures and the skin is approximated with fine wire.