Forearm Basilic Vein Research Articles

Radiocephalic Fistula Recovery Using the Forearm Basilic Vein: A Case Report

Dysfunction of the arteriovenous fistula for hemodialysis is a challenge for the nephrologist and the vascular surgeon. Although experience is limited, the use of the forearm basilic vein as outflow of the radiocephalic fistula has been considered. We report the case of a 60-year-old male, with cardiovascular comorbidities and a history of ischemic complications induced by the hemodialysis access. Drainage problems were present in the radiocephalic fistula and the forearm basilic vein was used in the vascular access repair. The procedure was successful, and the patient maintains a functional fistula, with secondary patency of 32 months, with no cardiac complications or hand access-induced distal ischaemia syndrome.

Radiocephalic Fistula Recovery Using the Forearm Basilic Vein: A Case Report

Dysfunction of the arteriovenous fistula for hemodialysis is a challenge for the nephrologist and the vascular surgeon. Although experience is limited, the use of the forearm basilic vein as outflow of the radiocephalic fistula has been considered. We report the case of a 60-year-old male, with cardiovascular comorbidities and a history of ischemic complications induced by the hemodialysis access. Drainage problems were present in the radiocephalic fistula and the forearm basilic vein was used in the vascular access repair. The procedure was successful, and the patient maintains a functional fistula, with secondary patency of 32 months, with no cardiac complications or hand access-induced distal ischaemia syndrome.

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

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.

Basilic vein transposition-radial artery fistula created using the no-touch technique .

To compare the functions and complications of forearm basilic vein transposition-arteriovenous fistula (BVT-AVF) created using the no-touch technique with that of conventional radiocephalic arteriovenous fistula (RC-AVF). The no-touch technique was used to created basilic vein transposition-radial artery fistula in 22 patients. Another 30 patients received surgeries for RC-AVF. The fistula functions and complications were compared between these two groups. The two groups did not differ significantly in the incidence of postoperative bleeding, limb swelling, infection, steal syndrome, fistula thrombosis, fistula aneurysm, fistula flow, fistula maturation time, Kt/v, and fistula median survival. Forearm BVT-AVF created by the no-touch technique is a good alternative access for patients in whom the standard arteriovenous fistula cannot be established.

Reassessment of forearm basilic arteriovenous fistula

It is widely accepted that an autogenous arteriovenous fistula is preferred over arteriovenous grafts and/or central venous catheters for dialysis access. To create an arteriovenous fistula, an adequate vein and artery are required. In many patients who require vascular access, the forearm cephalic vein has been damaged owing to multiple venotomies and/or intravenous catheterizations. Thus, the vein is often scarred or occluded, negating the first-line radiocephalic fistula. The forearm basilic vein lies in a medial position, making it more difficult to access for venipuncture or placement of intravenous lines.

Comparison of forearm versus upper arm basilic transposition arteriovenous fistulas demonstrates equivalent satisfactory patency

ObjectiveIn accordance with the Kidney Disease Outcomes Quality Initiative recommendations, attaining autogenous hemodialysis access, specifically via creation of radiocephalic arteriovenous fistulas (AVF), brachial-basilic (BB)-AVF, or brachial-cephalic AVFs, is preferred for mortality and morbidity benefits over catheter access in patients with end-stage renal disease. The aim of this study is to determine the suitability of forearm basilic vein transposition (FBVT) fistulas as an alternative access option by comparing outcomes with those of BB-AVFs. MethodsAll patients who underwent creation of FBVT between 2007 and 2015 were identified retrospectively in the electronic medical record and compared with a sample of patients undergoing BB-AVF placement during this time. Access patency was examined using Kaplan-Meier methods and Cox proportional hazards regression. ResultsWe included 34 patients with FBVT (median age, 54 years; 67.6% male) and 49 with BB-AVF (median age, 57 years; 42.9% male) in this study. There were no significant differences in comorbid conditions between the two groups, with the exception of hyperlipidemia (29.4% FBVT vs 53.1% BB-AVF; P = .03). Although those with FBVT were more likely to have had previous permanent access attempts (70.6% vs 38.7%; P = .002), and access attempts on the same extremity (44.1% vs 24.4%; P = .04), there were no significant differences in primary patency (46.9% vs 53.3%; P = .6), primary-assisted patency (65.6% vs 73.3%; P = .5), or secondary patency (68.8% vs 82.2%; P = .2) at 1 year when compared with BB-AVF. The risk of loss of patency was not statistically different for FBVT as compared with BB-AVF (hazard ratio, 1.37; 95% confidence interval 0.65-2.88; P = .4). This risk did not vary for those who had previous access on the same arm (interaction P = .8). Four fistulas in each group failed to mature. Only one infectious complication was identified in the FBVT group. ConclusionsNo prior studies have directly compared outcomes of FBVTs with BB-AVFs at 1 year or longer. Despite the increased difficulty of harvesting the forearm basilic vein, particularly in patients who have had prior access attempts, there was no significant difference in patency between FBVTs and BB-AVFs. FBVTs are a reasonable option for hemodialysis access, particularly in patients without adequate cephalic veins or who previously failed radiocephalic fistula attempts.

Upper arm basilic vein elevation as a solution for forearm ulnar-basilic arteriovenous fistulae with cannulation problems.

Ulnar-basilic arteriovenous fistula is an alternative option when a radiocephalic arteriovenous fistula is not feasible. We review our technique of basilic vein transposition in the upper arm for difficult to puncture forearm ulnar-basilic non-transposed arteriovenous fistulae. Three patients were referred for forearm ulnar-basilic arteriovenous fistulae with difficult cannulation where the forearm basilic vein was left in situ (non-transposed). Surgeon performed ultrasound examination confirmed a patent arteriovenous fistula with adequate diameter and flow, draining to the basilic vein in the forearm and into the upper arm. Recurrent new and resolving hematomas were present surrounding the forearm basilic vein resulting from difficult cannulation issues and problems maintaining needle position due the posterior-medial ulnar-basilic arteriovenous fistula position and mobility of the non-transposed forearm basilic vein. A basilic vein transposition elevation procedure was performed in the upper arm starting at the level of the elbow to a few centimeters below the axilla. Branches of the dilated basilic vein were ligated, the median cutaneous nerve was preserved, and the vein was elevated from its native position to a superficial and anterior location. Although difficult, dialysis access had been continued in the forearm during a brief period and none required catheter placement. Reliable dialysis access was successfully initiated using the newly transposed basilic vein in the upper arm 3-4 weeks after the procedure, maintaining arterial inflow based on the original ulnar-basilic arteriovenous fistula anastomosis at the wrist. None of the patients required further interventions with follow-up of 8, 15, and 22 months.

Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature Review

Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.

The forearm basilic vein looped transposition fistula as a tertiary option for upper limb vascular access.

The forearm basilic vein can serve as an option for haemodialysis access but may not be possible in cases where the wrist arteries are unsuitable. In this setting, the forearm basilic vein can be used in a looped transposition with a brachial artery anastomosis. The aims of this study were to assess the outcome of forearm basilic vein looped transposition as an option for vascular access. Data from January 2007 to December 2010 were prospectively collected and analysed. Outcome measures were operative success, complications, maturation and primary and secondary patency following 5 years of follow-up. From a total of 583 patients receiving autologous vascular access for haemodialysis, 24 (4.1%) underwent a forearm basilic vein looped transposition. The median age was 60 years (range, 27-80 years), with a slight male predominance (13 male:11 female). Mean follow-up was 34 months (1-60 months). Two patients died and other three were transplanted with subsequent fistula closure. All procedures were successful (100%); however, maturation failure occurred in one case (4.2%). No serious perioperative complications were observed. In two cases, we observed late false aneurysm formation requiring intervention. Primary patency at 1, 2, 3 and 5 years was the following: 77%, 62%, 21% and 10%, whereas secondary patency was the following: 81%, 71%, 61% and 32%, respectively. Autologous forearm basilic vein looped transposition is an effective surgical procedure for the creation of access for haemodialysis. This may be a useful option in patients with compromised peripheral arterial diameter or flow and should be considered in patients with a suitable forearm basilic vein.

Transposition, elevation, lipectomy and V-Wing for easy needling.

The purpose of this study is to report surgical techniques to facilitate cannulation of deep matured veins. 1) Basilic vein tunnel superficialization with rerouting in an anterior tunnel is mandatory for brachial-basilic arteriovenous fistula (AVF), mostly performed in a second surgical stage. The elevation technique, which could necessitate cannulation of the vein through the overlying scar, is not advisable. 2) Femoral vein superficialization is a one-stage surgical operation. Complications of this high-flow AVF are distal ischemia (diabetes and occlusive arterial disease are contraindications), iliac vein stenosis due to intimal hypertrophy and cardiac issues. Nevertheless, we have achieved high long-term patency rates (N = 70). Primary patency rates at 1 and 9 years were 91% ± 4% and 45% ± 11%, respectively. Secondary patency rates at 1 and 9 years were 84% ± 5% and 56% ± 9%, respectively. 3) Lipectomy for superficialization of the forearm radial-cephalic AVF is described for obese patients. Subcutaneous tissues are resected using two transverse incisions. Mobilization of the vein is avoided. At 3 years (N = 49), we recorded 63% ± 8% and 88% ± 7% primary and secondary patency rates, respectively. Anterior transposition of the forearm basilic vein is not necessary when using microsurgery for creation of distal ulno-basilic AVF. 4) VWING is a novel surgically implanted device to help buttonhole technique cannulation. It is too early to draw any conclusion from the preliminary published reports. Tunnel-transposition and lipectomy are efficient techniques to allow easy needling of deeply situated upper-arm basilic vein, and cephalic vein in obese patients, respectively.

Basilic Vein Transposition in the Forearm for Secondary Arteriovenous Fistula

Radiocephalic (RC) fistulae remain the first choice access for hemodialysis. The antecubital fossa is recommended as the next site. However, for some patients a basilic vein can be used to create an arteriovenous (av) fistula. We report a series of patients where the forearm basilic vein served as an alternative conduit for secondary procedures. Over an 8-year period, 30 patients who had a failed RC fistula underwent a basilic vein transposition. The immediate results were satisfactory. All fistulas were successfully cannulated. Cumulative patency was 93% after 1 year, 78% after 2 years, and 55% after 3 years. No ischemic or infectious complications were noted during the study period. The use of the forearm basilic vein to create a native av fistula appears to be a good alternative to procedures in the antecubital fossa or upper arm, thus preserving more proximal veins for future use.

Strategies for the Creation and Maintenance of Reconstructed Arteriovenous Fistulas Using the Forearm Basilic Vein

Reconstruction of an arteriovenous fistula (AVF) after an initial failure to provide long-term patency has been desired in the era when hemodialysis patients' prognosis is improving. The forearm basilic vein AVF should be considered, before an artificial graft shunt or an AVF in the cubital region. The present study was designed to establish a strategy for the creation and maintenance of AVFs using the forearm basilic vein. This study reviewed 76 cases of reconstructed AVF including 18 cases using the basilic vein (23.7% of total cases). The following four points were considered: arm positioning of the cubital flexion position combined with the forearm supinated position; several small skin incisions with a subcutaneous tunnel; sufficient venous dilatation using Fogarty balloon catheter; and early percutaneous angioplasty introduction for immature AVF. The primary and secondary patency rates were examined. A radiobasilic AVF was created through a subcutaneous tunnel in two cases. The primary and secondary patency rates of AVF with the basilic vein were 54.7% and 76.7% respectively, whereas those of AVF with the cephalic vein were 49.3% and 71.3%. The basilic was not inferior to the cephalic vein (P-value of the log-rank test for primary and secondary patency rates were 0.927 and 0.811, respectively). Early stage percutaneous angioplasty was effective in five cases with immature AVF. The forearm basilic vein was useful in AVF reconstruction and equivalent to radiocephalic reconstruction. Careful observation and percutaneous angioplasty during the early period after the surgery were essential for long-term patency.

Ultrasound Mapping of Arterial and Venous Patterns of the Upper Extremities in Patients with End-Stage Renal Disease

Objectives We sought to (1) to determine prevalence of high brachial artery bifurcation, forearm cephalic-arm cephalic connection, forearm cephalic-arm basilic vein alternate connection, and levels of basilic-brachial vein junction; and (2) to compare average diameters of forearm and arm cephalic and basilic venous segments according to the results of ultrasound mapping of the upper extremities (UE). Methods Consecutive ultrasound mappings were performed in 100 UE of 23 women, 69 ± 12 (47–84), and 27 men, 62 ± 12 (34–79) years of age. Brachial, radial and ulnar arteries and cephalic and basilic veins were scanned from wrist to axilla. Results Brachial artery bifurcation at the proximal/mid arm was noted in 25 UE of 18 subjects. Arm (a) or forearm (f) cephalic (ce) or basilica (ba) veins were absent in 18 (ace), 15 (fce), 10 (aba), and 14 (fba) UE, respectively. A forearm cephalic-arm cephalic vein connection was noted in 67 UE; of these, 9 (13.6%) also had a significant forearm cephalic-arm basilic connection. A primary forearm cephalic-arm basilic connection was noted in 5 UE, one with a secondary connection to the arm cephalic vein. The basilic joined the brachial vein at the proximal, proximal-mid, mid, mid-distal and distal arm in 29, 17, 26, 4, and 2 UE; a complex connection to radial/ulnar veins was noted in 14 UE. Average diameters were 4.2 ± 1.4 (1.2–7.8), 3.1 ± 1.1 (0.6–6.3), 2.9 ± 0.9 (1.4–4.9), and 2.2 ± 0.9 (0.7–4.5) mm for the arm basilic, arm cephalic, forearm cephalic and forearm basilic veins. Conclusions A significant prevalence of anatomical anomalies was noted, justifying mapping of the upper extremity vasculature prior to planning an arteriovenous fistula or prosthetic graft in patients with end-stage renal disease.

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

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.

The use of basilic vein transposition in the forearm as an alternative autogenous hemodialysis access

Purpose: To evaluate the basilic vein transposition into the volar aspect of the forearm and anastomosis with the distal radial artery, as a native vein for the construction of arteriovenous fistulas before shifting to the use of upper arm basilic vein or arteriovenous prosthetic graft . Methods: From January 2008 to December 2010, 75 patients who underwent AV access for hemodialysis in Zagazig University hospitals were retrospectively reviewed with following up the patients in the dialysis centers and the current AVF functions were evaluated in the outpatient clinic. Patients were grouped by the operation type into radiocephalic fistulas (RCF) in the forearm (above the wrist or mid forearm),forearm loop arteriovenous graft (FAVG) and forearm basilic vein transposition (FBVT). The outcomes compared were primary, secondary patency rates, maturation failure, and early or late complications. Results: 49 patients (65.3%) were males, 57 patients (76%) were diabetics, and 38 patients (50.6%) had previous access surgery. In 29 patients (38.6%) the cephalic vein was used as outflow vein, in 14 patients (18.6%) brachial vein was used as outflow for FAVG, in 7 (9.3%) patients midcubital vein was used as outflow for FAVG and in 25 patients (33.3%) the forearm basilic vein was transposed and used as outflow vein after anastomoses with the radial artery. Overall complications occurred in 36 (48%) patients over the follow up period and included hematoma (n=2), thrombosis (n=19), infection (n=9), ischaemic steal syndrome (n=3) and venous hypertension (n=3). Meanfollow-up was 15 months (range, 3-24 months). Maturation failure occurred in 3 radiocephalic fistula patients and in 4 FBVT patients.The primary patency rates for RCF, FBVT, and FAVG were 68.9%, 52%, and 42.8% at 12 months respectively. Conclusion: Whenever the presence of adequate forearm basilic vein with a suitable caliber, forearm basilic vein transposition is a good alternative autogenous option to be considered before forming an upper arm AVF or forearm AVG.

Placement of wrist ulnar-basilic autogenous arteriovenous access for hemodialysis in adults and children using microsurgery

The distal basilic forearm vein is frequently preserved and might be used more frequently for placement of an ulnar-basilic autogenous arteriovenous access (UB-AAVA) in the wrist despite the small size of the two vessels. The scarcity of publications led us to initiate a prospective study regarding the placement and outcomes of UB-AAVAs. Seventy patients (63 adults, seven children) with no usable cephalic vein in either forearm were selected consecutively over 4 years for placement of a UB-AAVA. The prerequisite was a clinically visible or palpable forearm basilic vein after placing a tourniquet. Regional anesthesia, prophylactic hemostasis, and a surgical microscope were used systematically. Secondary superficialization was performed in two patients. Most non-matured accesses were abandoned in favor of the placement of a more proximal autogenous access. Mean follow-up was 20 months (SD =15). Immediate patency was obtained in 94% of adults and 100% of children. Success (in-use access) was achieved in 60% of patients (38/63 adults and 6/7 children) after a mean postoperative interval of 80 days (SD = 64; range, 31-277). Failures included four immediate thromboses, one postoperative death, and 21 never-matured accesses. No steal syndrome was observed. Initial failures included, primary patency rates in adults at 1 and 2 years were 42% ± 6% and 30% ± 7%, respectively; secondary patency rates at 1 year and 2 years were 60% ± 6% and 53% ± 7%, respectively. Although patency rates are not as good as those achieved with radial cephalic-AAVA, the UB-AAVA is an alternative autogenous forearm access before the placement of any other access involving the basilic vein. The use of the surgical microscope is mandatory, and more than usual time is required to achieve maturation.

Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula

Since the publication of Dialysis Outcomes Quality Initiative (DOQI) guidelines, the use of native veins for the construction of arteriovenous fistulas (AVF) for hemodialysis has been highly recommended rather than prosthetic arteriovenous grafts (AVG). Upper arm basilic vein transposition (BVT) has been accepted widely, with superior patency compared with AVG, but only a few studies have reported outcomes of forearm BVT (FBVT). This study evaluated the efficacy of FBVT compared with direct AVF (DAVF) and AVG in a tertiary referral center. From January 2005 to December 2007, 461 patients underwent AV access for hemodialysis in Seoul National University Hospital. We retrospectively reviewed the medical records and dialysis sheets and evaluated the current AVF function in the outpatient clinic or by telephone interviews. Patients were grouped by the operation type: DAVF, FBVT, and AVG. The outcomes compared were primary, assisted-primary and secondary patency rates, maturation failure, and complications. The mean age was 59 years (range, 14-92 years), and 280 patients (60.7%) were male. By operation type, the 461 accesses were 389 DAVF (84.4%), 34 FBVT (7.4%), and 38 AVG (8.2%). Mean follow-up duration was 21 months (range, 1-51 months). The primary patency rates for DAVF, FBVT, and AVG were 67.6%, 41.5%, 35% at 12 months and 53.9%, 30.2%, 10.3% at 24 months, respectively. The secondary patency rates were 89.2%, 79.1%, 78.3% at 12 months and 83.8%, 74.4%, 64.9% at 24 months, respectively. Maturation failure occurred in five DAVF patients and in one FBVT patient. The infection rate was 0.3% in DAVF and 12.5% in AVG, but no infection occurred in patients with FBVT. Multivariate analysis revealed that age and history of previous access were associated with lower primary patency. Forearm BVT showed an acceptable, high 2-year patency rate and fewer thromboses and infectious complications than AVG. Forearm BVT could be considered before forming an upper arm AVF or forearm AVG, if the basilic vein is available.

ASDIN: Autogenous Side‐to‐Side Brachial‐Basilic Fistulas Without Vein Transposition: A Valuable Option?

An autogenous brachial-basilic arteriovenous fistula (BBAVF) in the upper arm must be considered before placing prosthetic grafts in hemodialysis patients with multiple failures of forearm AVFs. The aim of this observational study was to compare technical and clinical outcomes of a new construction technique for BBAVF (n-BBAVF) with that of the standard one-stage side-artery to end-vein transposed BBAVF (t-BBAVF). A n-BBAVF is constructed in the following way: basilic vein and brachial artery are isolated. Patency of the proximal and distal vein is verified by injecting warmed (37 degrees C) saline solution. A venotomy and an arterotomy of 4-5 mm are performed. The two vessels are prepared for a side-to-side anastomosis without transposition of the vein. The latter allows both an antegrade and retrograde flow along the basilic vein, both proximally and distally to the anastomosis with more sites available for the venipunctures of the dialysis. Thirty BBAVFs were constructed as the secondary or tertiary vascular access in 30 patients over a 4-year period: 17 patients with adequate forearm basilic vein underwent the construction of a n-BBAVF; 13 underwent the construction of a t-BBAVF. The construction of a n-BBAVF requires a significantly lesser surgical time (55.0 +/- 9.0 minutes vs. 115.0 +/- 18.0, p < 0.0001), has fewer surgical complications (5.9% vs. 46.2%, p < 0.0001), and a reduced time to first use (24.5 +/- 6.3 vs. 37.7 +/- 9.1 days, p < 0.0001) than that of a t-BBAVF. n-BBAVFs showed a relatively low rate of thrombosis per patient-year at risk (0.067 at 1 year and 0.099 at 2 years). The latter was significantly lower at 1 year when compared with t-BBAVFs (0.067 vs. 0.285; p < 0.004). Our policy of "all AVFs should be autogenous" led us to the construction of a vascular access which is based on a side-to-side anastomosis between the brachial artery and the basilic vein without transposition of the vein allowing both antegrade and retrograde flow into the basilic vein. The results of this surgical technique appear satisfactory.