Use of forearm basilic vein as an option of upper limb vascular access for haemodialysis

Mohamed Elshazli,Amr Mustafa,Samer Regal,Hossam Mustafa

doi:10.21608/mjmu.2021.81651.1019

Abstract

Abstract Authors : Mohamed ashraf elsayed elshazli, Samer abdelhamid regal MD , Hossam Mohamed Mustafa MD, Amr Mohamed Mustafa MD . Background: in our stuy , we aimed to evaluate the outcome of forearm basilc vein transposition and anastomosis to either radial or brachial areteries to create arteriovenous fistula for haemodialysis . Patient and Methods : This is an observational prospective study conducted from august 2019 to December 2020 at the Department of Vascular Surgery, Mansoura University hospital . 25 patients were selected for forearm basilic vein transposition (FBVT ) . 18 cases underwemt BB loop AVF and 7 cases underwent radiobasilic AVF . procedure was done under combined supraclavicular and local xylocaine 1% anaethesia . Basilic vein was harvested using multiple incisions then elevated and anastmosed to either radial artery in 7 cases or tunneled as aloop and anastomsed to brachial artery in 18 cases . Results: The mean age of patients who received an AVF was 56.96±9.61 years, with a range of 35 to 70 years, and included 19 men (76%) and 6 women (24%).18 cases underwemt BB looped AVF and 7 cases underwent radiobasilic AVF . patients were followed up for 1 year. 1ry patency rates at 3,6,12 months were 84% ,83.3%,82.6%. Conclusion: Radiobasilic or forearm brachiobasilic looped AVF can be used as an alternative option in case of cephalic vein inadequancy or if it was previously used for haemdialysis.

Highlights

It is essential to secure and maintain adurable vascular access with minimal risk of complications for proper dialysis in patients on chronic regular hemodialysis. 1 Autogenous arteriovenous fistulas (AVF) are the preferred mode of vascular access for maintenance hemodialysis (HD) followed by prosthetic grafts and central permenant catheters 1, 2,6
Arm brachiobasilic AVF was widely discussed by many groups either by one stage transposition or by two stages . but fewer studies have been discussing forearm basilic vein transposition (FBVT), its valuable role and relatively old route.[4]
Forearm basilic vein could be used before arm basilic vein transposition, providing another option for autogenous hemodialysis access.[5]

Summary

Introduction

It is essential to secure and maintain adurable vascular access with minimal risk of complications for proper dialysis in patients on chronic regular hemodialysis. 1 Autogenous arteriovenous fistulas (AVF) are the preferred mode of vascular access for maintenance hemodialysis (HD) followed by prosthetic grafts and central permenant catheters 1, 2,6. It is essential to secure and maintain adurable vascular access with minimal risk of complications for proper dialysis in patients on chronic regular hemodialysis. The basilic vein transposition (BVT) comes as a secondary option in patients with failed radio-cephalic fistula (RCF) or brachiocephalic fistula (BCF) .3. Arm brachiobasilic AVF was widely discussed by many groups either by one stage transposition or by two stages . But fewer studies have been discussing FBVT , its valuable role and relatively old route.[4] Forearm basilic vein could be used before arm basilic vein transposition, providing another option for autogenous hemodialysis access.[5] In patients with unfavourable anatomy , a looped transposition of forearm basilic vein (BV) can be created to facilitate more proximal anastomosis with brachial, radial or ulnar artery in the antecubital region.[7]

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Conclusion